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Emergency department (ED) registrars cut average registration times from 30 minutes to 15 minutes at Irvine, CA-based St. Joseph Health. In addition, the admission financial clearance process is completed, on average, in just 15 minutes. Assuming an inpatient bed is available, “this advances the patient’s transfer to the floor,” says Stefani Moore, regional manager of patient access.
The most difficult part of bedside registration was not having a “registration-friendly patient tracker,” says Moore.
ED registrars had no way of knowing whether the medical screening evaluation had been completed so they could go in to complete registration.
“A delay in completing the financial process in a timely manner increases the length of a patient’s visit by delaying the discharge and/or admission process,” says Moore. It also results in patient and physician dissatisfaction. “Insurance information is needed by the provider to facilitate the patient’s care plan,” she explains.
Moore worked with the hospital’s IT department to develop a new ED patient tracking system. “We created ‘status event’ indicators to notify the registrar when the medical screening exam was complete, when the patient is up for an admission, and when the patient is marked for discharge,” says Moore.
This system allows registrars to work closely with clinical staff to complete the registration process more quickly. “The registrar has an indicator on the tracker as well, for all staff to view,” says Moore. “This shows that the registration has been completed.”
Here are other changes made by St. Joseph Health’s patient access department to improve bedside registration:
• Registrars use mobile computer carts with a mounted scanner and signature tablet, for a completely paperless process.
• The department implemented several applications to assist in registration quality assurance, point-of-service collections, and insurance verification.
“We’ve been able to reduce the length of patient time in the emergency department significantly, whether the patient is discharged home or admitted into the facility,” reports Moore.
This system helps to decrease the number of patients who leave the ED without being seen, before they’re asked to provide financial information. “This improved revenue and claims reimbursements,” says Moore. ED point-of-service collections increased 67% over the previous year, she adds.
• Registrars are assigned specific zones or areas of responsibility, but they also work as a team.
If patient volume suddenly spikes, registrars in other areas assist their colleagues.
“If patients need to be quickly registered for discharge, or registrars are falling behind due to high volume, an ‘all-hands-on-deck’ process expedites the registrations,” says Moore.
St. Joseph’s ED registrars use portable phones for easy communication with each other and all clinical staff. Clinicians contact the registrar for these reasons:
ED registrars at Glenwood Springs, CO-based Valley View Hospital have a very good relationship with clinicians, which helps them to complete bedside registration. “However, it was not always this way,” says patient access manager Laura King.
To improve rapport with the clinical team, ED registrars found ways to help them, such as assisting with moving patients upstairs or taking care of family members during critical events.
“We sometimes babysit children when necessary,” says King. “We have taken care of dogs that have been left in the car that patients worry about.” Patient access also orders food, calls for transportation, and makes hotel reservations for family members, if necessary.
“These are things that ED staff appreciate because we are contributing to the patient experience,” says King. To help registrars to do their jobs, ED physicians now wear locators. “Registration staff knows when a physician is in the room with a patient, so they do not interrupt,” says King.
The department continuously evaluates process improvement to achieve better patient flow in the ED. “We want to eliminate as much rework as possible for the registrar and reduce turnaround time for the patient,” King emphasizes.