EXECUTIVE SUMMARY

At Albany (NY) Medical Center, adult surgical check-in starts bright and early at 5:30 a.m. Day after day, things predictably got backed up. This caused multiple problems in the department. Patients and family became anxious, OR times got delayed, and surgeons and nursing staff complained.

“We cross-trained staff in the ED for those very early hours, which was the end of the night shift for the ED,” says Catherine M. Pallozzi, CHAM, CCS, director of patient access.

The ED registrars are reallocated to adult surgical check-in as needed. The cross-training prevented the delays, keeping the schedule on track and patient satisfaction high.

“The ED staff is not utilized frequently,” says Pallozzi. “However, they will be factored into staffing plans if we have vacancies or critical shortages due to call outs.”

The ED registrars attend a formal training program, with unit-specific breakout sessions. “They are then paired with a learning partner for the operational training,” says Pallozzi.

Many Benefits for ED

The ED has benefitted from the cross-training in many ways. During a flu epidemic, registrars struggled to keep up with the influx of patients. “The cross training program provided the relief our department needed to manage this increase,” says Karen Gardner, CHAM, manager of patient access services for the ED.

Leaders assessed each patient access employee’s strengths and abilities. Based on this assessment, specific registrars were asked to assist in the ED.

Cross-trained registrars offer both immediate and long-term support, as needed, says Gardner: “The ED receives assistance covering our collection desk, registrations, and unscheduled system downtimes.”

Staff morale has increased significantly. “Each unit knows trained help is available if needed,” explains Gardner. This is reassuring both for the unit manager and for the associates on the front line. “Sending untrained associates for the sake of helping doesn’t help. Trained associates provide relief and true assistance.”

Employees see how their role fits into the “bigger picture” and overall workflow of the revenue cycle. “This has helped improve their commitment to excellence,” says Gardner. “Once you put a face to the next person interacting with the encounter, you tend to want to do your best work.”

In the ED, eight registrars are cross-trained to different units within patient access. Each associate is scheduled for at least eight hours per month in the units, so they can maintain their skill sets.

It’s not always easy to take ED registrars off the department schedule to attend the required training. “But the basic registration workflow is the same throughout patient access, making the transition back and forth easy enough,” says Gardner.

One senior registrar routinely works four hours in surgical check-in, then returns to the ED. “They enjoy the atmosphere in the different units, which are generally quieter than the ED, and the pace of patient flow,” says Gardner.

Proficient in all Areas

Any registrar being cross-trained is treated just as a new employee would be. “We have a standard of training that is not compromised for cross-training,” says Pallozzi.

Patient access has a goal of at least three employees cross-trained in every registration area. “We have approximately 50 staff members cross-trained to another unit beyond their primary unit,” says Pallozzi. Of this group, about half are cross-trained in two or more units beyond their primary unit.

The department’s senior registrars have no primary registration assignment. They are expected to become proficient in every patient access area. These include the main registration area, which handles walk-in labs and direct admits, radiology, non-patient laboratory, pre-admission testing, surgical check-in, and cardiac catheterization.

It takes 18 to 24 months to cross-train employees in all nine registration locations. Vacancies and vacations make it particularly challenging to accomplish this. “It is a significant commitment of time, for both the department and the staff member,” acknowledges Pallozzi.

Employees from low-volume areas can be pulled to cover higher-volume areas. “Cross-training allows for reallocation of staff or leveling out of staffing assignments,” says Pallozzi. “So no area is critically short-staffed.”

SOURCES

• Karen Gardner, CHAM, Manager, Patient Access Services, Emergency Department, Albany (NY) Medical Center. Phone: (518) 262-8544. Email: GardneK@mail.amc.edu.
• Catherine M. Pallozzi, CHAM, CCS, Director, Patient Access, Albany (NY) Medical Center Hospital. Phone: (518) 262-3644. Email: PallozC@mail.amc.edu.