Patients Scheduling Emergency Department Visits: A Plus for Nurses?


By Debra Wood, RN, contributor

Waiting for care in an emergency department ranks high among patients’ pet peeves. The problem remains pervasive and difficult for hospitals to eliminate due to increased demand for emergency care, boarding and other ED challenges.

Many hospitals are now offering nonemergent patients the opportunity to sign in for an ED visit at a participating hospital’s website and wait at home until the designated time--changing emergency department nursing and the ED patient experience alike.

“We’ve been very happy with it,” said Jennifer Dearman, RN, MBA, director of ambulatory administration at the University of California, San Francisco (UCSF) Medical Center in Parnassus Heights, Calif. On a daily basis, a number of patients log on and use the service.

The health information technology company InQuicker offers the service to hospitals, urgent care centers and primary care physician offices. UCSF employs the system in all three areas.

“We want people to get the appropriate care from the appropriate place,” Dearman said. “If they have a primary care provider here, they may be inclined to select their primary care provider if it is something that does not require an emergency department visit. They have the opportunity to self-triage.”

The InQuicker system projects wait times based on real-time ED patient traffic data at the hospital. The service is free to patients. It also identifies symptom keywords suggestive of a life‐threatening or debilitating condition and prompts those patients to call 911 or proceed immediately to the nearest emergency room.

Not only do patients with sore throats and other minor ailments not fill up the ED waiting room, nurses find the service beneficial, as well. Nurses receive a text notifying them a patient has scheduled a time, and they can log into the system to read a report with information about the arriving patient’s condition and treatment time.

“This allows the emergency department to prepare in advance for a patient’s arrival,” said Deb Morton, RN, MLDR, senior director of nursing at Dignity Health St. Mary’s Medical Center in San Francisco, Calif. For example, if the emergency department nursing staff is aware that a patient will be coming in soon with an orthopedic issue, the orthopedic room may be prepared. “This not only allows staff to be ready for the patient, it provides for a more expeditious treatment.”

UCSF nurses screen the reports as they come in and will often call patients to ask further questions or advise them to come to the ED immediately.

“The side benefit is, when that happens, you are getting [in the main ED] a ‘heads up’ that this type of patient is coming in,” Dearman said.

UCSF began using InQuicker three years ago, hoping to improve patient satisfaction--which it has. It also helps control patient flow, by assigning online registrants for the low-acuity area of the ED to less busy time slots.

“Most of the public does not realize the emergency department has ebbs and flows of busyness,” Dearman said. “You can direct traffic and make it attractive to come in when there are fewer people utilizing the service.”

The UCSF low-acuity area typically begins treating online registrants within 15 minutes of arrival, often with a midlevel provider. In addition to being seen more quickly, patients arriving when there is less volume have fewer delays for lab work and radiology studies.

St. Mary’s has found the online system can alleviate crowding in the emergency department.

“During times when the ED becomes very busy, staff has the ability to shift the next available check‐in until later in the day when it’s less crowded,” Morton explained. “The system also allows the ED leaders to ‘staff up’ for times when heavier traffic is expected.”

Morton cautioned that InQuicker is not a reservation service, nor is it appropriate for patients with life-threatening conditions. The normal triage process occurs and does not allow for scheduling. Those with an assigned time do not skip in front of other patients.

“Priority treatment is always given to those with the most urgent medical conditions,” Morton said.

InQuicker reports that the system can lead to improved patient quality metrics such as lower rates of patients leaving without being seen and shorter lengths of stay. It has found that 80 percent of its customers are seen within 15 minutes of the projected treatment time. If a delay is expected, InQuicker notifies the patient by phone or email.

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