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In addition to great customer service skills and a thorough knowledge of insurance, emergency department (ED) registrars need “a sense of urgency,” says Candace Koutsoulieris, ED patient access manager at Florida Hospital Orlando.
“The patient’s experience begins at the registration desk, and our clinical partners heavily depend on our speed and accuracy,” Koutsoulieris says. Here are some ways Florida Hospital’s ED registrars improve patient flow:
• ED registrars ask the right questions to expedite the initial registration process, then have patients go immediately to the triage nurse.
Staff use this scripting: “Hi. Are you here to see a doctor this morning/afternoon/evening? Can I please have two forms of ID? Please enter your social security number on the keypad. That allows me to find your medical information.”
“We verify information, protect the patient’s identity, and weed out the visitors from actual patients,” says Koutsoulieris. On average, the ED registers about 350 patients a day.
• ED registrars make expediting registration the top priority.
“Collections is very much a core part of our role. However, we decided to move our main focus to the patient experience,” Koutsoulieris says.
The top priority for registrars now is expediting the registration process and ensuring the correct health plan is selected. “We hand out surveys that ask about the registration process, and we are doing phenomenal,” says Koutsoulieris.
• ED registrars locate the patient’s correct medical record number.
Koutsoulieris instructs staff to always start the search with the patient’s social security number. “That is the only patient identifier that cannot be duplicated, because it’s a unique number for every patient,” she explains.
• Ensure the correct health plan is selected and that the patient’s demographics are up to date.
This step is handled by the department’s benefits representatives. “They observe anything that is necessary to complete the account,” Koutsoulieris says. “They then notify team members on the tracking board that benefits were added.”
Patient access staff members then visit patient rooms to verify demographics and collect copays. “It’s imperative that we confirm with the patients they have been seen by a doctor and have a plan of care before discussing collection or insurance,” Koutsoulieris adds.
• Registrars place a green sticker on the patient’s armband to notify the nurses that this patient was seen by registration.
This step helps move ED patients out the door quicker. “Nurses can discharge patients at any point, instead of directing them to the patient access discharge window, where they’d have to wait a bit longer to get their registration completed,” explains Koutsoulieris.
Simply getting access to the patient is a challenge for ED registrars at Portland-based Maine Medical Center.
“We are often circling the rooms and trying to get in,” says Patty A. Johnson, CHAM, manager of ED registration. “We never know who is going to be in there and what they are doing.”
Registrars often attempt to get into the room several times before completing the patient’s registration. “The doctor walks in, or somebody from radiology or labs comes in, and they want us out,” Johnson explains.
Previously, registration was completed before the patient was brought back to a room. It took an average time of six minutes to complete the registration. “We used to register them right when they came in the door, but we don’t do that anymore, in order to get them to a bed sooner,” says Johnson.
Registrars now do a quick check-in, and the patient is brought either to a treatment room or the waiting room, where registration is completed. “Patients like being brought back more quickly, but it now takes us an average of 17 minutes to complete the registration,” says Johnson.
Even after the registration is complete, the registrar has to go outside the room to scan documents, which adds time to the process.
Some information obtained by registrars can affect the patient’s clinical care, Johnson emphasizes. “Of course, the patient’s clinical treatment comes first, but there are some key pieces that clinicians need to know about,” she says. These key pieces include the patient’s legal next of kin and minors who present for treatment without parents or legal guardians. “Prescriptions and follow-up care are sometimes based on the patient’s health insurance,” adds Johnson.
The department is looking at implementing electronic alerts that tell registrars when it’s OK to come in and register the patient. “We are trying to figure out a workflow that will get our completion times down,” says Johnson.
The ED is switching to a “first-in, first-out” approach to complete registrations based on the order patients present, which is the model used by the admitting office and call center.
“Other areas seem to have good luck with that approach. It might not work in the ED, but we’re going to try it,” says Johnson. “We want to see if that will improve our scores.”