Patient access often struggles to find registrars well-suited to the hectic and tense ED setting. To weed out poor fits for this role, inform prospective candidates that:

  • patients are disruptive and occasionally violent;
  • they’ll be on their feet throughout the shift;
  • they must keep track of patients waiting and those arriving by ambulance.

Most registration areas operate at a somewhat predictable pace and volume, regardless of whether patients are scheduled or walk-in. In contrast, the ED absorbs sudden volume surges with very sick or injured patients. There is plenty of tension and even occasional violence.

“All access management wants to find that ‘perfect’ registrar for the ED during the interview process,” says Kim Rice, MHA, director of patient access at Shasta Regional Medical Center in Redding, CA. However, there is only a short time to assess whether the registrar has what it takes to succeed in the ED. Important skill sets include: multitasking, customer service, taking initiative, and working well with others. It’s equally important for patient access leaders to describe the reality of the ED.

“This gives the individual an idea of the controlled chaos that can happen,” Rice notes.

An argument in the lobby, a dissatisfied patient trying to leave prior to discharge, a patient or guest arguing with staff in a treatment room. All of this and more might happen at the same moment a chest pain or stroke patient presents with a life-threatening emergency. The ED registrar has to prioritize. After this reality check, some registrars conclude on their own that the ED is really not for them after all.

“This saves you time in the long run,” Rice says.

Rice pulls no punches about the job. ED registrars must be aware of who is in the waiting area and also watch for arriving ambulances. Registrars must keep track of patients who are waiting to be seen by the physician, and know who is ready for discharge.

“In the midst of that, they need to be prepared for the disruptive patient or visitors that may be expressing bad behavior,” Rice cautions.

Some candidates respond eagerly, stating that the job sounds like an interesting challenge. Others own up to the fact that they thought it was more of a “desk” job in an office setting. “I clarify to them that this is a job where you are on your feet and moving throughout the department during the majority of the shift,” Rice adds.

Feedback From Team

Shasta Regional Medical Center’s full-time, long-term ED registrars are the most reliable source of feedback on how new hires measure up, according to Rice. Their most common complaint: The new registrar is way too slow. This isn’t surprising, since patient flow in the ED setting is completely different from other registration areas.

“The goal is to interview the patient, provide a superb patient experience, answer any questions, and sign all consent forms, all under 10 minutes,” Rice explains.

Other duties, such as interviewing the patient and editing accounts, are factored into the employee’s overall productivity. Slowness isn’t necessarily a deal-breaker — at least not at first.

“The new staff is slower because they are learning all the areas to capture during their interview process,” Rice says.

Depending on what brought the person to the ED, it may be necessary to ask a whole host of additional questions. For instance, if an injury occurred at work, the registrar might want to call the patient’s employer. Important questions: “Has your employer been notified?”, “Was an injury reported to an insurance company?”, and “Who is it, and what is the claim number?”

“Usually, if it is a new injury, this hasn’t been done,” Rice explains. “We ask the patient to call us back with the information for accurate billing.”

Start With Small Goals

ED registrars start out with very small goals. Getting familiar with the signature forms is enough for the first week.

“Then, we focus on shortening the time with patients,” Rice says.

Quickly getting eligibility and benefits information from payer websites is a must-have skill.

“It is critical to be able to access these data during the time the patient is here, in case we uncover a change that maybe the patient isn’t aware of,” Rice notes.

For instance, the patient’s insurance might be invalid. At the point of service, registrars can talk with the patient face to face and offer assistance. Registrars’ most common questions:

  • How can we determine which patients are clear for registration to go in and interview them at the bedside?
  • What information is critical to collect from an ambulance patient?
  • What is the best way to interview patients at the bedside to make sure I am not missing data?

They get answers by scheduling some time with an experienced counterpart.

“Usually, this clarifies their questions, and the new employee improves,” Rice reports.


  • Kim Rice, MHA, Director, Patient Access, Shasta Regional Medical Center, Redding, CA. Phone: (530) 229-2944. Email: krice@primehealthcare.com.