No more waiting in the ED? Hospitals introduce online reservations

But legal experts warn that ED reservations create inequalities in care

Borrowing an idea from restaurants, more than 100 hospitals are offering patients the option to make online ED reservations, in an effort to increase satisfaction scores and decrease wait times, Bloomberg News reports.

Tenet offers the service—which is usually free—at 42 of its facilities. Patients are prompted to describe their ailments; if they involve serious symptoms such as chest pains, the system redirects the user to call 911 or go to the ED immediately. Some reservation services include mobile applications so that patients can check their individual wait status in real time. 

"If a mother gets a call that her child is sick and can't get an appointment with a doctor for a week, yet she can get an appointment in the [ED], why should that mother wait?" says Richard Easterline, who serves as Austin-based Seton Northwest Hospital's nursing director of the ED.

Hospitals say the reservations increase patient satisfaction, efficiency

The push for better patient satisfaction in the ED is partly prompted by a shift in hospitals' reimbursement.  An estimated $850 million in 2013 will be allocated to performance measures based on satisfaction scores from patients such as those in the ED. Hospitals also continue to grapple with long wait times in the ED, which in 2009 reached 58 minutes, on average, according to a CDC report.

Patient satisfaction scores and efficiency have improved since The Medical Center of Central Georgia began using an online reservation system, according to health system spokesperson Cyndey Costello Busbee.

"Because we make money on inpatient admissions, we want as many to move through our portal as possible as opposed to competitors," she says, adding that the system has "revolutionized the experience."

Experts weigh the legality of online reservation systems

But some legal experts warn that the reservation systems may be illegal because they violate a ban preventing hospitals from giving different treatment to patients for non-medical reasons. 

"Poor people don't have access to smart phones or computers," says Robert Bitterman, the CEO of Health Law Consulting Group, adding that although wonderful in theory, online reservations should be "kept out of the emergency department."

The popular InQuicker online reservation system has undergone legal review and does not violate any U.S. statutes, according to company spokesman Chris Song.

"A hospital's triage and throughput process remains the same for patients whether or not they use InQuicker, and care is always given based on the most urgent medical need," Song says.

Another wrinkle with online reservation systems: They may further burden already overcrowded EDs with low-priority cases, according to Sara Rosenbaum, a health law and policy professor at George Washington University. "If you're making an appointment, it's not an emergency," Rosenbaum adds (Armour, Bloomberg News, 11/26).

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