Effort targets intentional fraud, human error
With patient safety a heightened imperative from Joint Commission on Accreditation of Healthcare Organizations, and facing its own duplicate medical record problem, Truman Medical Center in Kansas City, MO, launched an initiative aimed at ensuring proper patient identification. The challenges are myriad, explains Nancy Stringer, director of patient access. "Some [of the problem] has to do with patients coming in and being one person one time and another the next time."
A man who knows he needs a particular medical procedure may use his brother’s Medicaid card to try to make sure the cost will be covered, she adds. "Or a person is in the country illegally and someone loaned him a visa to use." Then there are the cases in which someone is Willie Williams on one hospital visit, William on the next, and Billy in a later encounter, Stringer says. Adding to the mix — which of course also includes normal human error — are cases in which people give inaccurate Social Security numbers, she notes.
The hospital is addressing the problem on several levels, Stringer says, with educational efforts targeting registrars, clinical personnel, and patients. "We are making sure registrars understand proper search criteria," she adds. "For example, we probably have 40 or 50 Bob Smiths. We’re telling them to use multiple criteria when they put that name into the system. If there’s no match using name and birth date, don’t give up and add a new patient. Try the Social Security number — maybe the [patient’s existing file] is under Robert Smith."
In addition to educating registrars, Stringer notes, the hospital also is looking at getting registration software with a feature that searches for names that sound like the one being entered.
The idea behind educating care providers, she explains, is that they often are privy to information that patients may hide from registrars. "Sometimes the person is afraid because, for example, they may have [outstanding] tickets or warrants against them and feel we might notify someone about that," Stringer says. "So they use their brother’s name or birth date."
When the care provider begins taking the person’s history, but is looking at the brother’s chart, she adds, the deception may eventually be uncovered during their conversation. Other times, she says, the patient may have trouble communicating for one reason or another [during registration], but when the family comes in later, the family clears up the confusion. With these kinds of scenarios in mind, clinicians are being urged to share such revelations with registration personnel, she notes. "It’s everybody’s responsibility to make sure we have accurate information."
Patients, meanwhile, are being targeted with an effort called Operation Identification, Stringer says. "We will do a campaign about why [proper identification] is important."
The hospital’s public relations department is working on a flyer — using the colors red and black to make it stand out — that stresses the connection between proper identification and good medical care, she says. The flyer will encourage patients to bring along information to verify identity, and to give the same form of their name on each visit, Stringer adds. "It will be displayed at registration sites for patients to pick up," she says, as well as being handed out by registration staff.
In conjunction with the new emphasis by the Joint Commission for the Accreditation of Healthcare Organizations on patient safety, Stringer notes, the proper identification focus will extend throughout the organization. For example, she adds, "When clinicians do a procedure, they will use dual identifiers, such as [checking] the armband, [checking] the birth date, to verify that this is Suzie,’ as well as going over it verbally with the patient."
[Editor’s note: Nancy Stringer can be reached at (806) 404-3032 or at email@example.com.]