Being rushed to an ED takes a physical and emotional toll on anyone.

“Another layer of anxiety is added if patients are also afraid the wrong people may find out where they are,” says Ashley Franklin, a patient access associate at Northwest Hospital in Randallstown, MD.

If someone arrives with bruises, swollen eyes or broken bones who was not in a car accident or a similar circumstance, a red flag rises immediately.

“Patient access immediately alerts the triage nurse when someone arrives whom they suspect may be coming from a dangerous situation,” Franklin says.

The clinical staff then assess the patient. If indicated, a representative from the hospital’s domestic violence program is called to provide additional help to keep the person safe.

“If patients express concern about other people knowing where they are, patient access associates tell them about the confidential program,” Franklin says. If patients choose this option, organizations take these steps:

  1. The patient fills out a disclosure letter, and a patient access associate signs as a witness.
  2. The form goes into the patient’s medical record, and a patient access staff member changes the name in the hospital system.
  3. The patient access associate changes the patient’s ID bracelet and prints a face sheet with the new confidential name. The patient signs her or his actual name on that form. “The patient access associate documents the account in a memo, and the patient has a new identity,” Franklin notes.
  4. When the name change is complete, the patient access manager sends an email notification to all departments that could be involved with the individual’s care throughout her or his stay.

If ED patients are unresponsive, a request for anonymity can be made by police officers or the clinical staff.

“A disclosure letter must be filled out by the requestor with a written reason, and witnessed by a patient access associate,” Franklin says.

Organizations use a similar process for patients with scheduled procedures who are pre-registered over the phone. The patient access associate fills out the disclosure letter, and the patient signs it when he or she comes in.

“Throughout a patient’s stay, the new identity is used,” Franklin says. “When the individual is discharged, patient access changes the identity back to the person’s real name.”

Clear communication between all the departments involved in the patient’s care is necessary to avoid confusion.

“Diligence is required to make sure the new name is used, while retaining the real name on X-rays and medications that are needed,” Franklin explains.

Patients Can Opt Out

At Saint Francis Hospital & Medical Center in Hartford, CT, registrars flag the account as confidential if patients choose to opt out of the facility directory.

“This can be set at the patient level for all future encounters, or it can be encounter-specific,” says Susan Kole, director of patient access.

Registrars tell callers and visitors they have no information on the patient. Patients are made aware that they won’t receive mail, flowers, visitors, or incoming calls.

“Requests for patient information can be difficult if the patient has been flagged confidential but has given friends and family their location,” Kole notes.

Patients can provide a limited list of approved visitors. If the person requesting information is not on the list, no information is provided.

“Oftentimes, they have received a call from the patient,” Kole says. “But we are still obligated to respect the patient’s or security’s decision for confidentiality.”

Registration flags accounts as confidential if the patient is a gunshot or assault victim.

“Unidentified traumas are automatically flagged confidential until the name is verified and changed,” Kole says.

Security and the clinical staff review the accounts, and either leave the flag or remove it.

“Access to confidential patients is security-driven — and clearly marked — for anyone working in the patient record,” Kole says.


Susan Kole, Director, Patient Access, Saint Francis Hospital & Medical Center, Hartford, CT. Phone: (860) 714-6300. Email: