WOW’s success comes from a number of factors

Hours spent going through the flow’

Several key innovations contributed to the success of the Wipe Out Waiting (WOW) initiative in the emergency department (ED) of Paradise Valley Hospital in National City, CA, part of the Adventist Health System.

In addition to slashing patient wait times, the WOW program led to dramatic increases in point-of-service collection and coverage for unfunded patients and a calmer, more orderly waiting experience, among other improvements, according to patient financial services director Melanie Betancourt, FHFMA, and emergency services director Stephanie Baker, RN, CEN, MBA. Here are some of the contributors to the program’s success:

A new on-line financial screening process

Within the hospital’s existing Siemens MedSeries4 patient accounting software, explains Betancourt, is a functionality called USP (universal secondary payer) that typically is used in asking patients the questions needed to determine if Medicare should be the secondary payer on an account.

Even the Malvern, PA-based vendor points to the functionality’s use for that purpose alone, she says.

Betancourt points out, however, that she has made use of the USP to create a decision tree for on-line financial screening. "[Registrars] ask a series of questions and based on the answers, get direction on how to approach getting that person funded."

She suggests that users of the software take a look at other possible uses for the functionality, noting that it has greatly improved the hospital’s financial screening procedure.

Hours spent "going through the flow"

"Making certain we had accounted for all the various things that could happen — the different points of entry, the different conditions, how the security component would fit in" when the hospital closed the ED registration windows and went to a bedside registration system was crucial, Betancourt stresses. "We spent many hours going through the flow."

Part of that preparation involved the enhancement of the master board used to track patients’ progress through the system, she says. With the use of initials — not full patient names — to protect privacy, progress is indicated by movement across the board as various steps are completed, explains Betancourt.

Although the master board was not new, adds Baker, "we made it more specific to follow the WOW process, and added financial screening."

• Room-specific registrars

As part of the WOW program, registrars are assigned to work with the same bank of rooms and the same nurse throughout a shift, Baker notes. In addition, a registrar follows an account from start to finish, rather than handing off responsibility at various stages of the process, she says.

As a result, Baker adds, the quality of information has improved, and the amount of errors has been reduced. Contributing to those results is the ongoing "monitoring, reviewing, and tweaking" that take place, Betancourt says. "We have full-on quality control, with 100% of accounts validated to make sure before the bill is dropped that certain data elements are accurate."

• A three-bed overflow unit

Part of a "step-down" unit the hospital was having trouble staffing was called into service to help expedite ED patient flow, Baker says. "If necessary, we can put one nurse there and use it as an overflow area for three stable patients who have already been admitted and are waiting to go upstairs. That opens up three beds in the ED."