At Connecticut Children’s Medical Center, staff who handle scheduling, authorization, and financial counseling are working at home. However, the same is not true of emergency department (ED) registrars.

“Right now, we are struggling with decreased volumes of outpatient areas and redeployment of staff,” says Interim Director of Patient Access Jessica Budri, RN, MSN, APRN.

Staff who normally would be obtaining authorizations and financial clearance for upcoming procedures are instead busy notifying people that procedures are not happening as scheduled. After that, they have little to do, since volume at the freestanding children’s facility has not increased like many adult systems. “We redeployed staff who are cross-trained to the ED,” Budri says.

At University of Utah Hospital (part of University of Utah Health), a revamped ED registration process is in effect. As at many hospitals, patients presenting to the ED are triaged in an outdoor tent. “We have a couple of ED registration staff in full PPE [personal protective equipment] to mini-reg these patients,” says Junko I. Fowles, CRCP-I, CHAM, supervisor of patient access and financial counseling at Salt Lake City-based Huntsman Cancer Institute (also part of University of Utah Health).

Registrars collect just enough information to identify the patient (name, date of birth, and Social Security number) to create a medical record. ED registrars complete the registrations by phone and verify demographic information, insurance, emergency contact, preferred pharmacy, language, and spiritual preference.

Patients with non-COVID-19-related illness or injuries are brought inside, and the normal registration process is followed, but not always by a registrar who normally works in the ED. Admitting registrars were cross-trained to cover the ED some time ago, and it is coming in handy now. “ED staffing turnover has been an ongoing issue. We always had back-up staff to help out if the ED was short-staffed,” Fowles says. “That has helped us tremendously.”

Registrars are encouraged to use the employee wellness center and employee assistance program as needed. “We are witnessing increased anxiety and stress level among our employees,” Fowles observes.

Most registrars just want their concerns to be heard by colleagues. “Sharing their experience with peers is a common coping strategy, and seems to be working,” Fowles reports.

ED registrars are doing their best under unusual circumstances. Meanwhile, financial advocates at Huntsman Cancer Institute are telecommuting to reduce COVID-19 spread among the immunocompromised patient population. Admitting staff who complete inpatient registration at the University of Utah Hospital are doing so remotely for accounts with a “precautions” flag (meaning a pending or positive COVID-19 test).

All of this is going to affect revenue. For now, that is taking a back seat to safety. “We are aware of the negative impact the new workflow may have,” Fowles notes. Inevitably, some accounts are going to be missed because of the inability to complete in-person interviews and all of the necessary paperwork. “We are doing our best to minimize potential financial loss down the road,” Fowles says. “Our top priority now is patient safety as well as employee safety.”