Demand respect for patient access staff

Clinicians need educating on role

If a registrar is in the middle of collecting demographic information from a patient, he or she might be suddenly interrupted by a clinician entering the room.

At times, the clinician begins talking with the patient as though no one else is in the room, according to Jacque Hess, manager of patient access of OSF Healthcare in Peoria, IL.

“Registrars then back out of the room and try to come back to the room before the patient leaves the department,” she explains. “Registrars then feel embarrassed and frustrated.”

Hess says clinicians sometimes have difficulty understanding that registrars also play a very important role. “Registrars, at times, feel as though the clinical staff think the registrars have to automatically stop and leave the room when a doctor or nurse enters a patient’s room, no matter where they are in their process,” says Hess.

While most clinical staff members make registrars feel part of the team, “at times, registrars come across some clinical staff that make them feel less important,” she says. Registrars understand that there are times that they need to leave the room right away and make an attempt to finish their process later, says Hess, but clinicians don’t always respond in kind by allowing registrars to do their jobs.

“No one is trying to be rude or trying to make anyone feel like they are not worthy,” says Hess. “But I believe that an explanation of why everyone is important, when the new clinical staff are hired, would help.” Hess takes these steps to educate clinicians and registrars on the need to work as a team:

• Hess instructs her registration staff to tell the clinical staff where they are in the registration, stating, “I’m almost finished. It will just be a few more minutes.”

• If the clinical staff members allow the registrar to stay in the room, she tells them to make sure to say, “Thank you. It really helped for me to stay and finish the process.”

• If the registrars are having difficulty completing the process, Hess asks the manager to share that with clinical staff in department meetings.

“The registrars are included in every way, to make them feel part of the team,” she says. “I see improvement every day with the teamwork of the staff.”

Registrars, patients happier

At Mercy Medical Center in Oshkosh, WI, customer service scores in the emergency department increased by 30% after a new registration process was implemented, based on feedback given from clinicians and registrars.

There previously was a feeling that registrars and clinicians were at odds with one another, according to Linda Swanson, registration coordinator.

“We used to have the situation of ‘the ER department against the registration department.’ The walls were there,” she says. “To help knock those down, we needed manager assistance from both areas.”

Swanson found that both areas lacked understanding about what the other did, and both areas now ask clinicians and registrars to work alongside one another and observe what they do. “One of the neat things was we built a friendship between each department, and it’s still going strong,” says Swanson. “We all help one another.” Swanson also involved clinical and registration staff to determine the best process for registration from arrival until discharge.

“We literally took a few staff from each area, sat down for three days, presented the current process, and started fresh,” she says. The group discussed what they would want if they were patients and what patients complained about most regarding registration.

“We came up with a great process, which we then promoted to the rest of the staff of the two departments,” says Swanson. “We turned around the negativity, and our customer service scores have soared!” This is the new process used by emergency department registrars and clinicians:

• Registrars complete a “short-form” registration, meaning they just ask for the patient’s name, date of birth, primary care physician and chief complaint, and enter this information into the computer system to generate an account number.

• The patient is entered into the ED electronic record system, which alerts nurses that a new patient is logged in.

• Registrars call for the patient to be taken to a bed, or if the situation is emergent, they bring the patient immediately back without calling.

• The primary or triage nurse takes the patient’s vital signs, the emergency physician sees the patient, and the patient obtains laboratory and diagnostic tests as needed.

“We come to the bedside to do the registration and consents about 20 minutes after the doctor has been in to see the patient,” says Swanson. “We found that patients do not want to wait once they are discharged to do paperwork. Many would leave if you were not available or with another patient.”

The new process ensures compliance with the Emergency Medical Treatment & Labor Act (EMTALA), and ensures that registrars see the patients during breaks in the treatment process. “Patients like going directly to a bed, versus being triaged at a separate area and then taken to a bed. Rooming right away was key, as was having us come in later on,” says Swanson. “Our rate for patients that leave without seeing a registrar went down from 25 to one or two a month.”


For more information on educating clinical areas on patient access processes, contact:

Jacque Hess, Manager, Patient Access, OSF Healthcare, Peoria, IL. Email:

Linda Swanson, Registration Coordinator, Mercy Medical Center, Oshkosh, WI. Phone: (920) 223-1890. Fax: (920) 223-1807. E-mail: