You can reduce delays with wireless registration

Bedside registration can cut delays by 5-7 minutes

At Methodist Hospital in Indianapolis, ED patients are registered on a Compaq computer with a wireless network card, all mounted on a platform with wheels.

"This allows us to bring patients back to the room, if space is available, and register them at the bedside," says William H. Cordell, MD, a faculty physician at the hospital’s emergency medicine and trauma center.

Previously, a line often formed in the ED waiting room so patients could register before being placed in a room for evaluation and treatment, which increased overall length of stay, says Kathy Hendershot, RN, MSN, CS, director of clinical operations for the ED. To eliminate the "bottleneck" of registration, the decision was made to switch to bedside wireless registration.

"The goal was to help with our throughput and patient satisfaction," she explains. "We wanted to get away from the perception that we were more worried about insurance and money than caring for the patient."

Here are effective strategies to use when implementing wireless registration:

  • Invite resistant individuals to help implement the new system.

There was some difficulty "selling" the wireless system to the business and financial office, which registration clerks report to, says Hendershot. "There was additional cost of equipment, more physical demand on their staff and changing a process that worked for them," she explains.

The solution was to get key individuals involved early on in the process so they could participate in designing it, she says.

  • Consider cost issues.

The ED spent approximately $25,000 to update the six workstations, Hendershot says. "The cost was for top-of-the-line hardware and some software upgrades for our system," she explains. Hendershot adds that costs depend on the equipment you select and the square footage you need to cover.

  • Consider that the patient may be treated before registration is complete.

In some cases, the ED nurse and physician may have treated the patient before registration is completed, Cordell notes. "Thus the patient may have to wait until the discharge papers, which require registration, are completed."

Patients also must be registered into the system before X-rays can be obtained, he adds.

  • Track delays.

After the ED switched to the wireless system, a savings of 5-7 minutes per patient was demonstrated. "This does not seem like a lot, but it is when you are seeing volumes in the 300 per day range like us," she says.

She notes that a "straight-back-to-registration" process can accomplish a similar time savings for most EDs as long as beds are available, whether or not it is wireless.

To track progress, a specific performance indicator was identified. "We choose triage to room’ time as our first indicator to trend for improvement," says Hendershot.

Minimal improvement was shown, but a more dramatic change occurred in the "triage to physician" times. "This may be the best performance marker to keep," according to Hendershot.