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Scheduling a visit to the emergency room

This article first appeared in the St. Louis Beacon, Jan. 16, 2012 - Patients expecting relatively long waits for emergency room care are said to be surprised by what happens when they use a new program at some hospitals in the SSM system. Instead of showing up at the ER unannounced and taking a number, the patients have the option of contacting the hospital to hold their place in line and generally getting faster service when they walk in the door.

This isn't a system for patients facing sudden life-threatening conditions. It's intended for those needing minor treatment who don't want to sit in the waiting room watching CNN, or the clock, while waiting for service.

Although relatively new to the St. Louis area, place-in-line ER service already is established in some cities, particularly on the West Coast. One big difference is that the area SSM hospitals offering the service don't require a fee for holding your place in line. At Lakewood Regional Medical Center near Los Angeles, for example, patients are charged an extra $14.99 for the privilege of allowing the patient to reserve, in effect, a line ticket.

It might make patients feel better about Lakewood knowing that the hospital promises to void the fee if the patient isn't seen within 15 minutes after arriving. Some hospitals elsewhere had seen a fee as a way of discouraging patients from reserving places in line then not show up for service. Left unsaid was the possibility that a fee also might discourage patients from seeking treatment for relatively minor illness not requiring ER service.

But research has shown that fees did not affect patient use of the place-in-line system, according to SSM officials. They say SSM had considered a $9.99 fee but decided against it because they regard the program as a way to improve patient satisfaction during ER visits for minor emergencies as well as a way to boost hospital efficiency.

The program is based on software developed by InQuicker. The company's website says the software does not cause hospitals to bump other patients to serve those using the system. The computerized system allows hospitals to analyze patient flow, wait times and other factors to give patients the convenience of arriving when they can get quicker service. The company says that beats wasting time in crowded ER and urgent care waiting rooms.

SSM's online-only program works this way: Using a computer or cell phone, patients tap into Twitter, Facebook or www.ssmhealth.com/er and select an SSM hospital. Patients then choose a time to come in, fill out a form and, according to the SSM website, "Relax comfortably at home or the location of your choice until it's time to go!"

Patients testing the system so far have been pleased with the results, says Tina Lybarger-Ledyard, director of SSM Access/Outreach. During the first 10 days after the program launched on Dec. 26, she says 135 patients chose to reserve spots before seeking ER care. While that number may seem small, she says it's significant because it reduced the number of people in ERs, awaiting service.

"Those patients would have been sitting for an extended wait. Instead they are waiting at home for their time to come in. They were satisfied when they got here. A nurse has been in touch with them. We alerted the ERs that they were coming. A room is available when they get here, and they could go right in."

She and others stress that there are exceptions. A majority of patients who have used the service thus far have been able to get in within a few minutes of the projected treatment time that they selected, says Lisa Garner, a network director at SSM hospitals in St. Louis. "However, we tell people up front if more critical patients come in, if there is a major accident, we may have to call you and push your time back and you may have to sit and wait in the emergency room."

Sean Hogan, president of SSM Ambulatory Services, adds in a statement that while the new approach won't totally "eliminate waiting time, it will give people more convenient options when needing treatment."

Patients should go to the ER immediately if they are experiencing chest pain or stroke symptoms, such as dizziness, weakness or severe headaches, Lybarger-Ledyard says. She says SSM's system is the only one in the nation that uses registered nurses to "call the patient to verify the symptoms to make sure nothing is more serious."

She says patients have used the computerized system for varied minor conditions, including sprained ankles, small lacerations with no bleeding, and sore throats. "We get a lot of bladder infections. And we got a lot of back ache cases from people who were out shopping during Christmas."

A small laceration wouldn't seem to require ER attention. But SSM says the nurse who makes the initial contact will not make judgments about the patient's condition beyond whether it's so serious that it warrants an immediate visit to the emergency room rather than a place-in-line call.

"All sorts of people use the emegency room," Garner says, adding that if "you've twisted your ankle and you feel you are not in much pain and feel that you don't need immediate attention, you can call your doctor the next day, and we encourage people to do that."

On the other hand, she says, "There are always emergencies where you've sprained your ankle and you think it might be broken, that's perfect for this type of service."

Kristen Johnson, an SSM spokeswoman, says those who run Inquicker have found that the biggest patient flow occurs during "overnight hours, when it's 3 o'clock in the morning. You can't call your doctor or can't get into urgent care, but really need to be seen now."

Garner had no data on how many Inquicker patients have health insurance, but she says all types of patients are using the service. What she does know is that the patients seem pleased.

"We do callbacks, surveys to ask our patients how they feel about the service. One testimonial I remember is a patient who said she waited longer to get antibiotics at a pharmacy than she did to go through the whole process of being seen at the hospital."

She dismisses suggestions that the new approach is a fad, saying, "It's not really a trend. I think it's something that people will be going toward because everyone is trying to improve their customer service. One of the things that we find is that ER waits" result in an image of poor customer service.

The quick care ER service applies to five of seven SSM facilities. The two exceptions are St. Joseph Health Center in Wentzville and Cardinal Glennon Children's Medical Center on Grand Blvd. SSM says it is committed to treating a child at Cardinal Glennon within 30 minutes, depending on health conditions. In addition, people with limited or no access to the internet wouldn't be able to use the system.

Lybarger-Ledyard says 112 hospitals across the country are using the InQuicker program. The list includes Tenet, which owns St. Louis University Hospital.

Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.