Dread the wait in the ER? Make an appointment

Michael Granillo and his wife Sonya.
Michael Granillo and his wife Sonya.
Anna Gorman/KHN
Michael Granillo and his wife Sonya.
Dr. Stephen Jones discusses Michael Granillo's condition with Granillo and his wife Sonya.
Anna Gorman/KHN
Michael Granillo and his wife Sonya.
Michael Granillo came to the Northridge Hospital Medical Center's ER three times in the same week for his severe back pain, but left each time before being seen because of the long wait. He was seen the fourth time, after his wife made an appointment.
Anna Gorman/KHN

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Intense back pain sent 34-year-old Michael Granillo to Northridge Hospital Medical Center's emergency room three times within a week in June. Each time, Granillo stayed for less than an hour before leaving without being seen by a doctor.

"I was in so much pain I wanted to be taken care of now," said Granillo, who lives in Reseda and runs a hot dog cart business. "I didn’t want to sit and wait."

Then one morning he woke up feeling even worse. This time, Granillo’s wife, Sonya, tried something different: Using a new service offered by the hospital, she made an ER appointment online, using her mobile phone.

When they arrived at the hospital, Michael was seen almost immediately.

"That was my last resort and it worked," said Sonya. "He would have probably been at home in pain if not for the service."

In an era of increased competition driven by the nation’s health law, hospitals in California and around the country are hoping online ER appointments will help attract patients anxious to avoid long waits in a crowded and often chaotic environment.

"It makes for a happier camper," said Susan Dubuque, a national expert in hospital marketing. "When it comes to health care, consumers want more control over everything."

The system, adopted by Northridge and other hospitals in the Dignity Health chain about a year ago, is only for patients with emergencies that are not life threatening or debilitating, such as an ankle sprain or a fever. People with serious emergencies, such as chest pain or trouble breathing, are instructed to call 911 or go directly to an ER. 

To make an appointment online, patients must explain the reason for their visit and confirm that they can wait for treatment.

When patients get to the hospital, they still may be bumped by more seriously ill patients.

The approach makes business sense for hospitals because it lets medical staff know who may be coming through the door, and it makes patients more comfortable, hospital executives say.

Patients want to access health care the same way they do services in other industries, such as retail or travel, said Chris Song, a spokesman for InQuicker, a Nashville-based company that offers the online scheduling in California and 25 other states.

"When is the last time someone bought plane tickets at the gate?" he said.

Some critics say the online check-in system may be convenient but is not necessarily cost effective. If the country wants to decrease health care costs, patients need to be treated at the right place at the right time, said Dr. Del Morris, president of the California Academy of Family Physicians. Patients who can make appointments should do so at their doctors’ offices, he said.

"Emergency rooms are there to take care of people who have emergencies," said Morris, medical director of the Stanislaus County Health Services Agency.

Some patients who come in through the appointment service probably should be seen by a primary care doctor but either don’t have one or can’t get a timely appointment, said Dr. Stephen Jones, medical director for Northridge's emergency department. Others, like Granillo, shouldn’t wait for care, he said.

The Dignity chain says roughly 12,000 patients have scheduled visits for emergency rooms at hospitals in California, Arizona and Nevada. Recently, Dignity stepped up marketing, with billboards and ads online, on TV and radio, and in print. One TV spot features a woman sitting in a hospital waiting room chair – and then cuts to her on a living room couch with a dog, as the words on the screen read, "Wait for the ER from home."

Dignity Health, which is also offering the online reservations at urgent care centers and doctors’ offices, hopes that the new service will minimize wait times and boost patient satisfaction scores, said Page West, chief nursing officer. Under the Affordable Care Act, Medicare reimbursements for hospitals are partly tied to results on the patient surveys.

On the day of his appointment at Northridge, Granillo winced and shifted uncomfortably in the ER exam room.

"How are you feeling?" asked Jones. "Do you need more pain medicine?"

Granillo nodded and told him that his back and stomach both hurt.

After a CT scan, doctors told the couple that Granillo, as it turned out, had a very serious condition: lymphoma, a cancer of the lymph system.

His treatment began immediately. Sonya said if she had not made the ER appointment, Michael might still not know about his cancer.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation and not affiliated with Kaiser Permanente.