Registration errors mean lost reimbursement for hospitals, but more than money is at stake.
If a duplicate medical record is created, “it compromises safety, could delay care, or could result in inappropriate care,” says Lorraine Possanza, DPM, JD, MBE, program director of the Partnership for Health IT Patient Safety at ECRI.
It takes significant time and effort to combine records or remove inaccurate information. “It is difficult to clean up incorrect records after the fact,” Possanza says. “If the match is incorrect, then the errors cascade.”
It is not only one patient who is at risk, but also the patient whose record was matched incorrectly. If wrong information is copied from another record, or if incorrect matching of the record occurs, “then it is impossible to have correct billing,” Possanza cautions.
The costly mix-ups happen for all kinds of reasons: Patients with similar names, patients with “junior” or “senior” attached to their last names, or the names of husbands and wives are mismatched. “These errors can occur anywhere and in any setting,” Possanza observes.
Patient safety events involving registration “involve communication, documentation, tracking of patients, and the gathering and exchange of information,” Possanza adds.
If the patient was billed incorrectly, and then arrives for a similar service, it causes lots of confusion. The insurance claim is denied because the record mistakenly shows the patient already received the service. “Billing an incorrect patient could also result in a false claim issue,” Possanza explains.
ECRI recently received reports of some other patient identification issues:
• A patient came to the ED for a screening test, but their previous records did not come up. “The patient had been seen there previously, but the registrar thought it was a new patient,” Possanza says.
This can happen because of how the registrar obtains the demographic information. Asking for the name, address, ZIP code, date of birth, and cellphone number is ideal. “Recording the information in a standard manner creates a better match,” Possanza adds.
The address might be entered as Elm St., Elm Street, or Elm ST. The name might be entered as Tom Smith, Thomas Smith, Thomas A. Smith, or TA Smith. “Having additional information — for example, a cellphone number — may help to distinguish these individuals,” Possanza suggests.
Sometimes, records cannot be located for whatever reason, and a registrar creates a duplicate record. “Later, someone has to spend time to merge the records or to pull incorrect records apart,” Possanza laments.
Creating a duplicate record is more than just an administrative hassle. It prevents clinicians from viewing documented allergies, medications, or previous conditions. “These events really emphasize the importance of gathering information in the right manner, and completely,” Possanza says.
Registrars can ask questions such as: “Are you giving me your legal name?” or “Is this the name that appears on your driver’s license and insurance card?” Just because information appears on a screen does not mean it is correct or current. “It still requires verification, and potentially modification or updating,” Possanza notes.
• A patient received a call about a positive COVID-19 test, when in fact they never underwent a test. “This reveals a problem with the exchange of information at registration,” Possanza says.
The patient who received the call had not been seen recently. The patient who should have been called with the positive result had a similar name. Even though registration caught the error, deleting any information from the EHR is never easy. Therefore, it is possible the result remained in the incorrect patient’s record, which could affect future care, Possanza adds.
• An uncle and his nephew had the same name, and their charts were mixed up. The mistake was discovered when the nephew, a child, was undergoing preoperative screening. The nurse asked about a condition noted in the record, and the mom insisted her child did not have the condition. At that point, staff realized they were using the wrong chart — the one for the uncle.
• A patient’s Do Not Resuscitate Form was scanned into the incorrect medical record. “These are potentially dangerous situations where patient wishes may not be followed,” Possanza warns.
It is important to correctly “match” the patient with the correct information, whether it is an allergy, medical history, current health condition, or wishes for care. “This involves information-gathering, information-documentation, and information-matching,” Possanza explains.
• Antibiotics were about to be administered intravenously to the incorrect patient. The order was written for a patient with the same last name but a different first name.
“In this instance, the nurse caught the error prior to the administration of the antibiotics,” Possanza reports.
• A patient tested positive for COVID-19, but received the results by letter instead of phone. This meant it took several days to notify the patient. In this particular case, the patient underwent a procedure at an out-of-state hospital, then traveled back to their home location.
The problem was no one asked for the patient’s cellphone number at registration. Since only the patient’s address was in the chart, that is all the information available to staff.
• Registrars selected the wrong patient after putting in the first few letters of a last name and finding what seemed like a match. Drop boxes contain multiple patients with similar names. Sometimes, the names are exactly the same.
“This is not unlike the list of email addresses that come up when you begin an email and you are selecting someone to write to,” Possanza offers.
Registrars quickly see that a name matches and just assume it is the person standing before them. “When pulling up a record, they don’t realize it is not the same person. Instead, they just move forward,” Possanza says.
The problem may be the way the screen appears. Information is cut off, so registrars cannot view other pieces of data that would clear things up. “The information can be verified with the individual,” Possanza says. “That is the first step.”