Patient access departments at University of Colorado Hospital and Loma Linda University Medical Center coped with sudden volume surges in the aftermath of mass shootings. Patient access managers say these things would have helped:
- an on-call list for registration staff;
- cross-trained employees to come register ED patients;
- drills to test how well medical record numbers follow patients through the hospital.
Only a handful of registrars were on hand at 1 a.m. when the first victims arrived at University of Colorado Hospital on the night of the July 2012 mass shooting inside a movie theater in Aurora, CO.
Not all patients arrived by ambulance. About 20 came by police car or private vehicle. “The patients arrived in groups or one at a time. There was not a ‘known’ number to expect,” says house supervisor Paige Patterson, RN, BSN, who oversees the patient access department.
To address sudden volume surges in the future, some employees were cross-trained to do the registration process at the ED entrance/ambulance bay. “The ED registration is specific, but our general registration staff are able to assist with emergent registrations,” says Patterson. “We have only used the non-ED registration staff during disasters and disaster drills.”
On the night of the 2012 disaster, however, this process was not yet in place. “We did not have an on-call list for registration,” adds Patterson. “Staff just called those whom they thought could come in.”
The department was able to get some additional registrars in to register patients and help in the command center. “A call list would have been helpful, because we had some staff say, ‘If you had called me, I would have come in,’” says Patterson.
On the day of the 2015 San Bernardino, CA, mass shooting, having a group of employees cross-trained to register ED patients was greatly helpful to registration manager Elizabeth Mendoza at Loma Linda (CA) Medical Center. “We had to get staff to register anywhere from five to 20 people at a time,” Mendoza says.
Several years ago, the hospital’s financial counselors, insurance verification, and customer service registration representatives were cross-trained to do ED registration. “When we need help, I buddy them up with my staff. That is how we train them,” says Mendoza. In addition to shadowing ED registrars, financial counselors come work in the ED during system downtime to keep their skills fresh.
Though greatly helpful during last year’s mass casualty incident (MCI), the cross-training wasn’t done just for disasters. The same process is used for any other sudden surge of volume that occurs in the ED, with cross-trained staff called in about twice a month. “Once we get the page that we have a possible MCI coming in, we contact our other registration areas to get assistance, or we call in people early,” Mendoza says.
Not all registrars are comfortable working in the ED setting. “They are not as comfortable with seeing these types of patients,” says Mendoza. “We need people who are able to step in and help us, who can do our job the exact same way we would.”
Some employees give it a try, but are simply not suited for the ED setting. “We’ve had people turn around and say, ‘I tried it, and this is not for me,’” says Mendoza. Others found they wanted to work in the ED setting. “I have hired employees from other areas after they’ve come down to help us and have really liked it,” says Mendoza. (See related story in this issue about how patient access coped after the mass shooting.)