Initiate account number at, or before, triage

Irving, TX-based VHA reduced waiting times by initiating an account number at or before triage, says Jeanne McGrayne, RN, MSN, director of emergency department consulting.

This tactic doesn’t necessarily get patients in the room faster, but it gets care initiated faster. Many EDs have moved registration to the bedside, but McGrayne cautions that you’re just moving a slow process farther down in the system unless you have an account number up front.

"With bedside registration, we have found that physicians tend to compete for access to the patients’ registration. You can get a patient in the room, and you can get a doctor in the room; but if you don’t have an account number, you can’t order X-rays or labs," she says.

"You’ve got a doctor in the room ready to order things, but the registration hasn’t been done yet. If you initiate an account number right when the patient walks in the door, the doctors can order anything they want as soon as they see the patient," McGrayne points out.

She notes that many EDs do not have triage nurses assign account numbers because hospital administrators feel strongly that that task should be done by a registrar, not a clinician.

Most of that resistance is based on fears that the triage nurse, more concerned with assessing the patient’s condition than creating paperwork, inadvertently may create duplicate records by recording a patient’s name as "John W. Smith," for instance, when the hospital already has an account for him under "John Smith," McGrayne explains.

"Medical records and finance people think that is an egregious sin," she says. "This can be a big dispute within the hospital. But if you really want to get patients through the ED faster, this is the way to go, and you need to address those other concerns along the way."

Also, VHA reduced waiting times by making sure nurses are assigned to specific rooms so that there is a clear handoff, McGrayne advises.

When that room is available, the triage nurse knows the assigned nurse also is available, she adds.