Making appointments for emergency department visits

More emergency departments are experimenting with appointment reservation systems for patients.
More emergency departments are experimenting with appointment reservation systems for patients.

Over the years, the culture of emergency departments (EDs) has changed. Far gone are the days when EDs were used solely for emergencies; today, we treat patients not only for their true emergencies, but for their warts, their hang nails, and their other less-than-emergent problems. As the number of people visiting the ED continues to rise, clinicians are faced with the problem of having to finding a place for these patients. When the ED becomes full, patients who can wait are sent out into the waiting room until a spot is ready for them. But what, if as the patient, you were able to call ahead and put your name on a waiting list? Just like at your favorite restaurant, you could make a reservation; when you arrive, you would get the next available spot.

As crazy as this might sound, more and more EDs are experimenting with this method.  Simply put, patients are able to document their complaint and pick an appointment time. When they arrive, they'll be placed first in a line of people that have been triaged into their same category.

I find this concept incredibly interesting, and I have mixed feelings about it. For instance, if I frequently suffered from kidney stones and felt the beginning pain of a stone, I would probably be interested in signing up for an appointment. After all, if I was going to have to wait 2 hours to be seen, I would prefer to wait at home rather than in the ED. However, if there was a chance I could be seen before the next available appointment, I would probably take my chances and come to the ED in hopes that a spot may suddenly open up. If I had a complaint like a sprained ankle, and really just wanted an x-ray and some crutches, I wouldn't mind making an appointment; I could elevate my leg and be relatively comfortable in my home, rather than in the waiting room chairs.

In these cases, making an appointment may not be a bad idea. It would help to keep the number of people in the waiting room at a minimum, and make for happier patients. However, I‘m concerned about those patients who are stoic, and may not realize how sick they actually are. A patient who thinks they have a simple skin infection may sign up for an appointment, not realizing they are febrile, tachycardic, and hypotensive. They might wait 2 hours for an appointment, when in reality they meet the criteria for sepsis and need immediate treatment. The idea of making an appointment may dissuade them from getting emergent attention.

It's difficult to predict if this trend will continue to grow over the next 5 years. As people continue to rely on technology for the ease and convenience it offers, clinicians may see the benefits of creating an online appointment system. However, patients may be unclear about what makes a true emergency, may instead utilize resources like urgent care centers. There may also be a rise in the number of patients who are without health insurance and willing to wait for appointments, that have no other option but to use the ED for even their minor problems. 

In my opinion, I think this trend will stay right where it is, with only a small percentage of people making appointments. After all, clinicians must remember that to those without medical training, the smallest malady may be thought of as life threatening. Those patients will come into the ED as soon as a problem occurs to be reassured by a clinician that they will be okay. If I had no medical training, there's a good chance I would be one of those patients.

I think that patients with serious emergencies should not even think about making an appointment, but come directly to the ED. Otherwise, patients should do whatever makes them happiest. If a patient with a nonemergent problem would rather wait at home and then come in, I will be more than happy to see them at their appointment time. If that patient would rather wait in the waiting room, I will gladly see them when a bed becomes available. After all, a patient who is happy at the start of their ED stay may view their experience in a totally different perspective than a patient who arrives unhappy – and treating happy patients can make your day just a little bit brighter.

Jillian Knowles, MMS, PA-C is an emergency medicine physician assistant in the Philadelphia area.

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