Too Many ‘John Does?’ Tighten Processes for Unidentified Patients
Names might be too similar
Unidentified patients pose safety concerns because of the possibility of duplicate medical record creation and patient misidentification. The following approaches may help minimize safety concerns.
• Use different dates of birth for pediatric and adult patients.
• Take and store a photo of all patients presenting for services.
• Create a video on patient identification best practices
Recently, six patients, including several children, presented to the ED at Maine Medical Center in Portland after an accident. None had any identification.
“We had issues around the names and dates of birth being too similar,” says patient access manager Patty A. Johnson, CHAM. This called attention to concerns about the process used for unidentified patients. “It works well, except if we were to have a mass event. The names are too close for comfort,” says Johnson. When multiple anonymous patients presented simultaneously, it caused confusion for clinical staff.
To address this issue, the department created new procedures for patients whose identity is unknown at the time of arrival. These steps are taken:
- Registrars select a checkbox for “anonymous.” This creates a unique name and medical record number for the patient.
- Anonymous patients use a combination of XXGreek/NATO characters for first and last name, and four random letters are used as a middle name, such as “XXDigamma, Theta CWSY.”
- The anonymous patient date of birth is 01/01/1901, except if the patient is a minor. If the anonymous patient is a minor, the date of birth can be manually changed to reflect the patient’s estimated age. “Previously, the date of birth used for anonymous patients did not allow clinical staff to access pediatric clinical dosing calculations,” explains Johnson.
- The anonymous patient’s Social Security number is entered as “111-11-1111.”
- Once patient access has identified the patient, the name, date of birth, and Social Security number are updated. “If the patient does not have an existing medical record number, the patient keeps the medical record number originally assigned to the anonymous name,” says Johnson.
Unidentified patients present risks that go beyond revenue loss. There is always a chance the patient will be misidentified by the clinical team.
“Patient safety is a concern when patients are not able to be properly identified,” says Dahlialee Gonzalez, patient access manager at Hackensack Meridian Health — Palisades Medical Center in North Bergen, NJ.
The department recently implemented finger scanning technology. This makes identification effortless if patients were seen at the facility previously. “It helps minimize the creation of duplicate medical record numbers,” says Gonzalez. “We also take and store a photo of all patients presenting for services.”
If the patient has an existing medical record number, registrars check the photo on file to be sure that is indeed the same person. However, this isn’t always possible during a mass casualty event or disaster. “At times, we are not able to perform the finger reader function due to the patient’s condition,” says Gonzalez.
If multiple unidentified patients present at the same time, a number sequence is used to identify them, such as John Doe 1 and John Doe 2. The department has not had a mass casualty event or disaster that involved unidentified pediatric patients. The current process uses a uniform date of birth for all unidentified patients.
“The process will need to change if children are involved,” acknowledges Gonzalez. “For children, we will need a different date of birth that would identify the patient as a child.” (See related story on a patient identification video created by the department, in this issue.)
Video Shows Patient Identification Best Practices
An educational video on patient identification best practices was a great help to the patient access department at Hackensack Meridian Health — Palisades Medical Center, North Bergen, NJ. “The video spread awareness throughout the organization of the importance and critical aspect of the role of patient access in Patient Identification,” says patient access manager Dahlialee Gonzalez.
These three scenarios were used:
1. A “quick reg” is done in the ED.
The video showed the registrar asking for two identifiers — the patient’s name and date of birth — and the patient presenting legal ID.
2. A patient presents to radiology for a study.
The video shows the registrar asking for two identifiers: the patient’s name and date of birth. Once the patient is registered, the radiology technologist compares the name and medical record number from the patient’s ID band with the order, to ensure it’s the same person.
3. An inpatient is not wearing an ID band and the patient is unable to speak.
The video shows the nurse checking for the patient’s ID band and notices it missing. The nurse immediately calls patient access, and a patient access representative goes to place the ID band on the patient. Before the band is place on the patient, the primary nurse identifies the patient to ensure the name and medical record number are the same,” says Gonzalez.
Patient access helped the “actors” to understand their processes completely before the video was filmed. “This ensured they followed the exact process that we have in place,” says Gonzalez.
- Dahlialee Gonzalez, Patient Access Manager, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ. Phone: (201) 295-4801. Email:
- Patty A. Johnson, CHAM, Patient Access Manager, Maine Medical Center, Portland. Phone: (207) 662-2102. Email: .
Unidentified patients pose safety concerns because of the possibility of duplicate medical record creation and patient misidentification. Several approaches may help minimize safety concerns.
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