Cut registration waits by 60 minutes: Watch your satisfaction scores soar
Incorrect orders are obstacle
Wait times in registration areas are “generally a huge dissatisfier,” says Brenda Sauer, RN, CHAM, director of patient access at New York Presbyterian Hospital in New York City. “Many times, we have patients waiting for beds because patients don’t leave when we anticipate, clinical cases go longer than expected, or emergencies occur.”
Emergency department wait times were cut by 60 minutes with a quick registration process used by clinicians and registrars, and satisfaction scores rose four points as a result, reports Sauer. As the triage nurse assesses the patient, the registrar does an abbreviated registration, which is then completed at the bedside.
“When we first started the process, one challenge was developing the teamwork between nursing and the registrars,” says Sauer. “The registrars now sit next to the triage nurse. They are very much a team.”
Bedside registration means registrars need to work closely with nurses and physicians in order to do their jobs. Physicians have become accustomed to waiting a moment for registration to be completed when they come to examine the patient, for example. “It forces the registration staff to collaborate with the clinical staff working around them, so everyone can get their job done,” says Sauer.
Missing, incorrect info
Missing authorizations and incorrect orders are two common reasons for long waits in registraion areas at Baptist Health Corbin (KY), reports Andy Dunn, director of patient access services.
“It is definitely a patient dissatisfier. The customers always blame it on the hospital when we are at the mercy of the physician’s office,” he adds.
If incorrect orders occur, patients must wait 30 minutes to two hours to be registered. “Wait times could be cut by 30% if orders were correct,” Dunn says.
Providers’ offices are often unaware of what can hold up a patient’s registration, such as a missing diagnosis, an incorrect diagnosis, an incorrect social security number, an ordered test not selected, a missing signature, or a nurse’s signature, which invalidates the order. “If it happens early in the day, the patient must wait until the physician office opens,” Dunn says. “Scheduled procedures do not share the same delays, since we have the order ahead of time. Our big wait times come from walk-ins.” Registrars tell patients, “I am so sorry for your delay. We are working with your physician to receive a corrected order so you may receive the best of care.”
“We have a physician liaison who works with us to educate physician offices on areas of improvement,” says Dunn. “We create helpful hints and reminder sheets for her to distribute to the offices.” [The helpful hints are included with the online version of this month’s Hospital Access Management. For assistance, contact customer service at email@example.com or (800) 688-2421.]
Avoid “undue stress”
Medical necessity not being met is the most common reason for patients leaving registration areas dissatisfied at OCH Regional Medical Center in Starkville, MS, according to Steven K. Cochran, patient access supervisor over admissions and ER registration.
“I strive to keep open communication with our clinics on the importance of adequate documentation and information required by us that is needed from their offices, to decrease a patient’s wait times,” he says. (See related stories on how the hospital’s online pre-registration system decreased wait times and what to tell patients if delays occur, below.)
Cochran says one of his primary goals, after being promoted to supervisor of patient access, was to “to set the facility apart from others, where wait time and efficient registrations and admissions are concerned.”
Previously, when an additional test or procedure was added, a clerk in the clinical area was the one who made the patient aware of the need to sign an Advance Beneficiary Notice (ABN). Many patients had concerns about how their insurance coverage would be affected and wanted to know more about medical necessity. “The clerks were not familiar with the rules and policies regarding this,” says Cochran. “Sometimes the patients got a little irritated that they were unable to answer any questions they may have had regarding this.”
At that point, the clerk would contact someone from patient access to come and educate the already-frustrated patient. To avoid problems, clerks now contact patient access as soon as they learn an additional test or procedure is being added.
“The majority of the time, we have the information needed to prevent adding any undue stress or concern to a patient,” says Cochran.
For more information on how patient access can address wait times in registration areas, contact:
• Steven K. Cochran, Patient Access Supervisor, OCH Regional Medical Center, Starkville, MS. Phone: (662) 615-2581. Fax: (662) 615-2619. Email: firstname.lastname@example.org.
• Andy Dunn, Director, Patient Access Services, Baptist Health Corbin (KY). Phone: (606) 523-8656. Fax: (606) 523-8609. Email: email@example.com.
• Brenda Sauer, RN, CHAM, Director, Patient Access, New York Presbyterian Hospital, New York City. Phone: (212) 746-4630. Fax: (212) 746-2891. Email: firstname.lastname@example.org.
Care is delayed? Offer patients info
Keep them informed
Members of the patient access staff hand a pager to anyone waiting more than a few minutes in a registration area at OCH Medical Center in Starkville, MS, which frees the patient and family to leave the immediate area.
“It is very similar to what restaurants use for wait times, and allows patients to visit the cafeteria, gift shop, or coffee shop,” says Steven K. Cochran, patient access supervisor over admissions and emergency department registration.
Whatever the reason for the wait, patient access employees resist the temptation to point fingers outside the department. “One of the most important things is to not ever place blame for a wait on another department or individual,” he stresses. “People want to feel they can trust that every individual involved in their visit is doing the best they can to provide excellent service”
The goal is to give patients a strong impression that your facility is working as a team to provide excellent service and healthcare, says Cochran. “Make sure that you are more than willing to be their source of information, for questions and concerns that they might have,” he says.
At New York Presbyterian in New York City, registrars use this scripting: “Hello, Mr. or Mrs. ____. I want to update you on the status of (whatever they are waiting for). Is there anything I can do for you?” Brenda Sauer, RN, CHAM, the hospital’s director of patient access, says, “We find that if we keep the patient informed as to why there is a delay, they are more understanding.”
If waits are significant, registrars don’t hesitate to offer food vouchers for the hospital’s cafeteria. “The staff has complete autonomy in determining when to give a voucher,” she reports. “On average, we use one or two a day.”
Patient access employees round on patients in the waiting room every 30 minutes to give them an update as to why they are still waiting. “Many times, it is because they are scheduled to be admitted and the bed they need to go to is not available,” says Sauer. “If this is the case, my staff will call the unit to find out what the delay is and share it with the patient.” For example, registrars might tell patients that there is an emergency on the unit holding up the room or that their room is being cleaned. “It lets the patient know we have not forgotten them,” says Sauer.
Online pre-registration helps your wait times
Fewer patients have to wait to be registered due to a new online pre-registration system at OCH Regional Medical Center in Starkville, MS.
“We limited it to one clinic’s use until we got the bugs worked out,” says Steven K. Cochran, patient access supervisor over admissions and emergency department registration. “We had to make sure all the necessary fields were included in the online page, and set up a procedure on how to handle the actual patient flow when they arrived.”
The hospital’s website features a link to the online services, which are pre-registration and bill payment. Patients are directed to a user-friendly “fill-in-the-blank” page. “At the end of the day, this drops into a queue that one of our registrars is assigned to work,” Cochran says.
The registrar creates a “pre-reg packet” that is pulled when the patients arrive. At that point, registrars simply need to verify the patients’ information and direct the patients to the proper departments for their tests or procedures. “It has been really convenient for patients in speeding up the process, especially on high-volume days,” reports Cochran.
To publicize the new service, the hospital sent press releases to local media and ran several full and half-page ads in the local paper. Patient access leaders distributed informational cards explaining how the pre-registration service worked. “We hand-delivered those to the clinics and explained the procedure to the clinic staff,” says Cochran. “We then distributed them to all patient-accessible areas throughout the facility.”
Patient access areas added a column to sign-in sheets and asked patients if they had pre-registered online. “If they did not, we tell them about it,” he says. “We are seeing eight to ten patients a day pre-register online, and numbers are steadily increasing.”