Identifying the correct person at registration “ensures downstream systems have the correct clinical record,” says Brenda Pascarella, CHAM, associate director of patient access at Albany (NY) Medical Center.
If not caught, incorrect patient identification can lead to administering the wrong medication or performing tests that were ordered for another patient. “Ensuring staff is following the patient identification policy can prevent a wrong patient from being chosen,” Pascarella says. Her department recently made two changes to this process:
- When searching for a patient, registrars use the first five letters of the patient’s last name and the first two letters of the first name.
- The IT department added system prompts to alert registrars if they are not following the proper look up procedure. If the correct search criteria are not used, an alert states, “Training issue detected. Please adhere to the 5-2 rule.”
“In addition, if the user hasn’t found their patient in the system, the ‘add new’ button has been made red,” says Pascarella, noting this makes it less likely the registrar will create a new record for a patient who was seen previously.
Diane Eck, a patient access manager at Middlesex Hospital in Middletown, CT, says, “an error in registration can delay treatment or result in improper treatment, which can be life-threatening.”
If the incorrect patient is registered, clinicians will not be aware of allergies, and they will not have access to the medical history. “This could result in the patient requiring a higher level of care, or even death,” Eck says.
If the incorrect address is on file, patients who arrive via ambulance from skilled nursing facilities could be transported to the wrong address. If the incorrect phone number is listed, tests ordered for ED patients may return after the patient is discharged. “Should the phone number be incorrect, we have no way of contacting the patient,” Eck says. “They may be in need of immediate medical care.”
To prevent all of these errors, registrars use two identifying factors (name and date of birth) and ask the patient to verify the spelling of both their first and last names. Engaging patients by asking for their information instead of just reading it to them is especially important. “You may not have their full attention. They may just agree with everything you have said,” Eck offers.
Additionally, registrars verify all information without skipping any fields. “If there is a field to fill in, it is important,” Eck stresses.
Accurate registration processes can prevent an allergy or drug interaction. “It is also about protecting patient financial and personal safety,” says Karoline Pierson, director of patient access at North Memorial Health in Robbinsdale, MN.
Staff can prevent registration errors (e.g., creating a new medical record for an existing patient or pulling up an incorrect patient file) by understanding cultural variations in name spelling or order, using multiple data points to verify identity, and asking open-ended questions.
“Ongoing training on all of these elements — and a prompt review when errors do occur — builds a culture of accountability,” Pierson says.