March 9, 2011, 7:55 pm

If You Can Make an Appointment, YOU DON’T NEED AN ER!

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Well, I am happy to say that I am NOT old enough to remember when cardiac monitors were simply oscilloscopes.

Is it just me or does that uniform look extremely uncomfortable? It’s like she has a restraint around her waist. If it gets any tighter it will blow that cap right off her head!


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Krista, your book should be on its way from the publisher.

Many thanks to all who entered the Emergiblog drawing!

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I actually wrote this post in November.


Why I did not post it then, I do not know, but here it sat in my pile of drafts, neglected and unattended.

It’s still relevant, so I’m posting it now.

(Hat tip to the Emergency Nurses Association’s Facebook Page for this information. The article can be found here.)


This is so wrong.

You can’t make this stuff up.

It seems an emergency department in Memphis, Tennessee is now taking online reservations for their services. Yes, you heard that right, you can now hop online and select the time you would like to be seen for your “emergency”. Just pay $15.00 and you can give your chief complaint, your medical history and your list of medications ahead of time, saving you time and trouble when you pop in with your pesky problem!

What if the problem is serious?

The computer won’t let you register and flashes a “Call 911” sign at you.

But wait! There’s more!

If you are not seen within 15 minutes of your scheduled time, you money is cheerfully refunded!

I’m not kidding.


If you can make an appointment for an ER visit, you are not having an emergency!

Repeat it with me: the use of emergency departments for non-urgent problems is an inefficient, expensive practice.

If you are making an appointment for an “ER visit”, what you are doing is making an appointment for a clinic masquerading as an ER. And if the “ER” actually a fast track that is staffed and run separately from the ER (aka an “urgent care” or a “clinic”) then, don’t advertise it as an emergency service.

The very nature of emergency care means never knowing what will come through the doors or when it will show up. The patient population is fluid, the acuity level varies widely with no way to predict work flow. You can make appointments and schedule to your heart’s content but all the online reservation systems in the world cannot guarantee that an emergency department will be able to see a patient in a set time frame.

And the “money back” guarantee?



How can we expect the public to have realistic expectations of health care, specifically emergency care, when it gets treated like your local nail salon? Make an appointment and get your money back if the totally unreliable, unforeseeable and often chaotic world of the ER can’t meet its promises.

It’s bad enough that patients have unrealistic expectations when they walk through the door. They expect to be seen instantly. They don’t expect to wait for labs. They want meds given to them and not to have to go to the pharmacy. And now, in a community in Texas, they can make an appointment to be seen in an emergency department.

I wonder if the nurses and doctors on the front lines had any input into that.

I don’t have much information, but it just reeks of corporate input.

Maybe I’m missing something, but I just don’t get it.


  • Candy

    March 9, 2011 at 8:38 pm

    It’s also happening in California. So far 8 hospitals here use the service, InQuick ER, to let patients make “appointments. This is the most of any state, and of course, most of the places are in SoCal.

    InQuickER says they’re an online pre-registration and check-in service that provides more convenience, control, and communication to emergency room and urgent care patients. It’s all about “patient satisfaction,” (remember how important Press Ganey is). You simply go to the website, find a facility that’s close to you, choose an available time, complete the registration (and pay the $15), wait at home, then show up. If you aren’t seen within 15 minutes, you get your $$ back. They tell you if you have a REAL emergency, don’t use the service, but go immediately to an ER. Here’s the link:

    And here are the fortunate California hospitals: Fountain Valley Regional Hospital (Fountain Valley); John F. Kennedy Memorial Hospital (Indio); Lakewood Regional Medical Center (Lakewood); Loma Linda University Medical Center (Loma Linda); Los Alamitos Medical Center (Los Alamitos); Placentia-Linda Hospital (Placentia); San Ramon Regional Medical Center (San Ramon); and San Antonio Community Hospital (Upland).

    If ERs had connected urgent care centers, with a nurse doing triage (sending patients either to urgent care, to an ER bay or HOME with an appointment later with a physician), we could cut down on all of this. Of course, that will never happen.

  • Karin RN
    Karin RN

    March 11, 2011 at 1:50 am

    I agree with you. That is totally, not right.

  • RehabRN

    March 12, 2011 at 12:00 pm

    I’ve thought about this for a while. It would be a great business plan. Since they’re doing “boutique” medicine, they should also do “boutique” urgent care. Take the people who pay the most first, triage them and triage the other folks after that.

    Keep the ER clear for the real emergencies: heart attacks, strokes, etc.

    And yes, a kickin’ ER triage nurse or two would make beaucoup bucks for someone who could get this implemented.

    One hospital here in RehabLand (a level one trauma center) now posts it’s ER wait times on the web site. If it keeps the non-urgent care folks out, I guess it’s worth it.

    Just my 2 cents…

  • […] At Emergiblog, Kim writes about ERs and appointments. […]

  • David Harlow
    David Harlow

    March 18, 2011 at 10:26 am

    Kim — I agree with you. I was at a health care social media conference yesterday where a marketing manager from a hospital system told – approvingly – about seeing ER wait times posted by hospitals. I had the same visceral reaction to that as you did to the whole idea of making an appointment at an ER. If you can take the time to check the waiting time, or to make an appointment, it’s not an emergency, and you shouldn’t be going to an ER (and the hospital should not be billing anyone for an ER visit – clinic visit, sure, but not an ER visit which by its nature is much more expensive). Call it urgent care, call it walk-in outpatient service, but don’t call it an ER.

  • The Nerdy Nurse
    The Nerdy Nurse

    March 20, 2011 at 6:12 am

    But what if only have a -little- emergency? Can I make an appointment for your ER then, because its Sunday and I cant think of anything better do with with the back pain I’ve been having for 10 years.

  • Shauna Harrelson
    Shauna Harrelson

    March 21, 2011 at 10:29 am

    An appointment online for an ER???? Whaaaaat?

    I am 100% with you Kim, that is absolutely unreal! The few times that I have been to an ER I certainly did not think of making an appointment, it was more along the lines of hoping that I arrived there PERIOD, in one piece, and preferably alive!

    After a car accident, sirens screaming, I had no idea what I was in for on the way to the nearest ER. Looking back on that certain ER visit, and then reading your post, I just can not imagine anyone having the time to place a reservation! A reservation??

    Do they also serve a nice dry Chardonnay upon arrival??

  • Phyllis Robinson
    Phyllis Robinson

    March 21, 2011 at 7:01 pm

    Well we actually have an ER here in the Baltimroe area that has a turn around time of 10 minutes. You can actually look on Facebook and see the waiting time!

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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