Web scheduled ED visits

I have now heard everything. I recently saw an advertisement for a “new concept in emergency care.” Roughly, this is how the process works:

*John Q. Public pays a small fee to belong to an on-line service.

*Mr. Public completes a form on-line giving their pertinent medical history, allergies, list of medications, and family history. The form is kept for use by the emergency department when or if the patient comes in for treatment.

*If the Mr. Public develops a “non-serious medical condition” and wishes to be treated in the 24/7, full service emergency department of a local hospital, he signs on to the site.

*Mr. Public completes a makes an appointment to be seen in the emergency department within 15 minutes, or at any time up to 6 hours later. He also gives a brief description of his current medical problem.

*The hospital guarantees that Mr. Public will be seen within 15 minutes of his scheduled time, or the visit is free.

I appreciate how enticing this is to Mr. John Q. Public. No waiting, no repeating your history fifteen times, and avoidance of peak times in the emergency department. (Apparently the computer program schedules these appointments based on the volume of patients currently in the emergency department.) Mr. Public now sleeps better at night, thinking that when he needs a doctor, he’ll be able to see one within fifteen minutes of the time he starts his computer.

I appreciate how enticing this is to the hospital and to the emergency physicians. With computerized scheduling of non-emergency visits, the emergency department can staff more efficiently. No more peaks and valleys of patient volume. If the program is sophisticated enough, it might be possible to schedule similar complaints in clusters, thereby achieving more efficient use of the ancillary services such as lab and x-ray.

I just have one question:

WHAT ARE WE THINKING?!?

This program promotes non-urgent care in the emergency department. As emergency physicians, we now officially do everything. We take care of emergencies – in the ED; we take care of inpatients – in the ED; we do minor ( and sometimes major) procedures – in the ED. Now we are scheduling appointments? The only thing we don’t do yet is make house calls………..or is that the next website to blossom?