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Improve relations with ED clinicians, managers
The secret to any process improvement in the ED is the relationship that your registration staff have with the clinical staff and management, according to Tina Nadrasik, patient access manager in the ED at Bronson Methodist Hospital in Kalamazoo, MI.
"I have a good relationship with the ED manager and the unit coordinators," she says. "We often help each other identify processes that need improvement and work together to accomplish this."
Recently, it was noted that there often were misunderstandings between the verification staff and the case managers on the floors, says Nadrasik. "There was a need for better communication," she says.
Registrars often would put notes into the computer system that case managers misconstrued, and vice versa, says Nadrasik. "Often, case managers and verification did not understand what each other was trying to say," she says. "They did not talk the same language."
Case managers lacked understanding of "who does what job" in the verification office, she adds.
The case managers came to realize that in fact, the "urgent verification phone line" they were using consisted of a single person, as opposed to a whole team of people waiting to answer their phone call, Nadrasik says. "Case managers wanted to have less wait time on pending accounts, and more accounts with correct primary care physician information," she says. "One of their goals is to make sure we have that right the first time."
Registrars now use a central fax number with a designated person to contact, which eliminated delays in figuring out who to talk to, says Nadrasik.
Timing is better
Often, ED registrars would wait until a certain patient was seen by a physician to enter the treatment room, only to find the patient already had left, says Nadrasik.
The hospital's registration staff is decentralized in the units, she adds, so ED registrars work alongside the ED clinical staff. "Most of the time, before a patient is discharged, a ED nurse will let the registration staff know 'I'm discharging room 23,'" she says. "There is good communication."
To get the timing even better, a second initiative is being piloted with a registrar working in the ED using a mobile cart, says Nadrasik. "The registration person can see when the physician leaves the room or that the patient was taken out of the room," she says. "None of this would be possible without a good working relationship between registration and the ED staff."