Choose the right location for registration computers
Once the decision has been made to switch to bedside registration, another choice has to be made: Where should the computers go? Situations vary, with some EDs opting to put computers inside patient rooms and others using laptops. Here are some pros and cons of each method.
• Computers on wall-mounted brackets in patient rooms. At Scottish Rite Children’s Medical Center in Atlanta, a computer was installed in every treatment room. "We have since questioned whether that was a good decision because we’ve had problems, such as kids playing with them or people spilling coffee on them, says Joseph Simon, MD, former director of the ED at Scottish Rite. "Because we’ve had some problems we didn’t anticipate, we’re having some second thoughts about having the computers in the rooms."
Ordering of ancillary tests right in the treatment room may seem like an attractive prospect, but it may not work in reality. "In theory, the nurse can order labs and the doctor can pull up labs, but in practice that doesn’t work," says Simon. "We found they don’t generally want to do that in front of the patient. They want to get the results somewhere else, sit and think about it, compose themselves, and decide how they’re going to present the information to the patient."
• Computers installed outside patient rooms. A possible compromise is to install computers directly outside treatment rooms, but that creates another problem. "If put outside the room, you have people standing up giving financial information in the hallway, which isn’t the best thing to do," says Simon.
• Laptops. This system can be the best of both worlds, allowing caregivers to bring computers right inside the treatment rooms while maintaining mobility. But there are potential drawbacks. In addition to being a considerable financial investment, laptops need to be linked with the hospital’s main system.
ED managers at St. Ann’s Hospital in Westerville, OH, discussed all the possibilities for computer location.
"We talked about doing it manually, but for workers to fill something out manually and then put it in the computer would be a waste of time," says Bobbi Allen, RN, center leader of the hospital’s emergency care center. "We also considered plugging in the laptop and booting it up each time it was used, saving the information, and later downloading it into the main computer, but we felt that would take so much extra time, it might not be worth doing it."
It helps to have the hospital’s information systems (IS) department on your side. "We had top-notch IS guys who always approached it with an I-know-we-can-do-this’ attitude," says Allen. "In the end, they fiddled with it and came up with a wireless way to network with our main system."
If laptops are used, a portable cart is needed to carry registration supplies. At St. Ann’s, a search was conducted for carts to serve this purpose, but none were found. Eventually, carts were specially designed by the hospital’s IS and facilities support departments for the ED’s bedside registration.
The entire ED staff pitched in ideas. The cart had to be ergonomically correct so the staff could do registration standing, and it needed to roll easily, says Allen. "They look like an overbed table but are sturdier and bigger on the bottom so they won’t tip over." The stands hold the laptops, consent forms, pens, and patient handouts. Six carts were manufactured by a local company for approximately $800 apiece.
Quality of the laptop is another issue. "At first, we got refurbished laptops and didn’t pay a lot of attention to quality," says Allen. "We now have made a commitment systemwide to buying only a high-quality laptop. After using them for awhile, we realized they took a beating, as well . . . because we see about 50,000 patients a year."
At St. Ann’s, laptops are powered with wheelchair batteries, with three laptops in use at a time. After every shift, the laptops are recharged. "We originally had cadmium batteries, which were self-contained. We were real pleased about it, but it didn’t work out because we just ate them up," says Allan, adding that the manufacturer may not have understood the department’s needs.
The decision was made to switch to rechargeable wheelchair batteries. At 7 a.m., registrars take the three laptops they have been using and put them in a room to recharge, says Allen. "In the beginning, it was tough for people to remember. Somebody would say, A laptop isn’t working,’ and it would turn out that the battery hadn’t been recharged. But like anything, there was a learning curve. Now, it’s like second nature."