There is probably no area that is more challenging to register patients than a busy, chaotic ED. Often, patients are too ill to provide the necessary information to complete registration. People arrive without identification, insurance cards, or credit cards, making collecting copays difficult or impossible.

To make things even more challenging, clinicians frequently are impatient with registrars, says Darlene Powell, patient access system manager for the ED and financial services at Bronson Methodist Hospital in Kalamazoo, MI. There are several sources of tension between clinicians and patient access:

  • Clinicians often tell registrars they are taking too long with patients at triage.

“We limit the questions to name, birthdate, and take driver’s license when possible,” Powell notes. “We try not to ask anything else until the patient goes back to their room.”

  • Clinicians believe registrars ask too many questions.

Few realize all the information that is involved in completing a patient’s registration. For instance, worker’s compensation cases are very time-consuming because of all the required paperwork.

  • Clinical staff complain registrars are in the way when clinical staff are trying to assess the patient.

“We watch the tracking board to determine the best time to enter the patient’s room so we don’t interrupt,” Powell offers.

  • Clinical staff believe registrars should not ask patients for money when patients are in the ED.

Since this perception was the root of much tension, patient access leaders took a proactive approach. They contacted clinical leaders, asking to be put on the agenda at nursing and physician staff meetings.

“They give us about 10 minutes. We come prepared with our topic, so it moves quickly,” Powell reports. Patient access asks that clinicians refrain from discussing financial matters with the patient. Instead, clinicians are asked to state, “Patient access can assist you with that.”

Patient access also raises the topic of collections during monthly “touch base meetings” with nursing and physician leadership. They explain the reasons collections are necessary in the ED, and what the process is. “We explain it is after the patient has been cared for and ready for discharge,” Powell says. “We aren’t interfering with patient care at all.”

Clinicians’ buy-in can be a game-changer when it comes to collections. If they resent it, patients pick up on it. “Once clinicians understand the process, it prevents them from telling patients, ‘You don’t need to worry about that,’” Powell says.

If clinicians interfere with the registration process in any way, registrars report the issue to a supervisor. Patient access leaders then follow up with clinical leadership.

“We discourage confrontation so that the patient doesn’t witness inappropriate conversations between staff,” Powell explains.