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Revamp process for sudden surges in registrations
Cross-training is key
This spring during the H1N1 epidemic, registrations through EDs increased dramatically nationwide. The processes of virtually every patient access department were put to the test.
Cross-training is the key for any unexpected surge in patient volume, according to Catherine M. Pallozzi, CHAM, CCS, director of patient access at Albany (NY) Medical Center Hospital. "Patient access has spent a great deal of time cross-training for all units within the department," she reports. "As a leadership team, if the need arises — and it does often — the manager is on the front line, the associate director is on the front line, and I am on the front line."
Pallozzi says that as a patient access professional, she deals with staffing shortages "on a regular basis."
"When there is an influx of patients due to H1N1 or just another day of high census, we have learned to manage with the staff we have," she says. "Our secret is being able to flex staff by bringing staff from other areas. Also, having managers with the ability to work the front line in not only their unit, but in multiple units."
Due to the cross-training effort and the team approach, Pallozzi's patient access department was able to appeal to other units to assist in the emergency department during a particularly high-volume period. "We were able to pull six to eight staff members," says Pallozzi. "Their willingness, our need, and the cross-training effort resulted in coverage being achieved."
"Volume surges, including flu epidemics, can certainly present challenges to patient flow," says Bridget D. Puryear, director of patient access at The George Washington University Hospital in Washington, DC. "Flexibility, including allocating staff to other areas, is critical when facing fluctuations in patient volume."
Staff are cross-trained to complete all types of registration. Training for the registrar position entails an admit, discharge, transfer (ADT) system review, a review of department policies and procedures, and hands-on training, including an actual patient registration in the emergency department. Staff need to obtain proper identification of the patient, complete a full registration, verify insurance, and collect the copayment.
"Having a good, quick registration process is key," says Puryear. "There are many challenges. However, proper patient identification is important. And ensuring that the full registration is completed prior to the patient's departure from the emergency department is critical."
Either prior to triage or during the triage process, staff obtain the patient's name and date of birth, primary care physician, and reason for the visit. This allows them to create an account number for their emergency department visit, while allowing the clinical staff to move forward with the patient's care.
"Facilities want to be sure that their patient access representatives know their quick registration process," says Puryear. "You need a strong process in place to complete the registration process prior to the patient's departure from the emergency department. Having good communication between the patient access team and the emergency department is also very important."
If staffing shortages should occur due to H1N1 or seasonal flu, Puryear says her department's contingency plan is to utilize part-time and per diem employees to meet the increased workload. "The part-time and per diem employees have completed all of the competencies required for the job and have been fully trained in the positions," she says.
[For more information, contact:
Catherine M. Pallozzi, CHAM, CCS, Director, Patient Access, Albany (NY) Medical Center Hospital. Phone: (518) 262-3644. Fax: (518) 262-8206. E-mail: PallozC@mail.amc.edu.
Bridget D. Puryear, Director, Patient Access, The George Washington University Hospital, 900 23rd Street, N.W., Washington, DC 20037. Phone: (202) 715-4341. Fax: (202) 715-4935. E-mail: firstname.lastname@example.org.]