Stop misconceptions on patient access role

Respect is the issue

When a trauma patient arrives via ambulance, access services staff must obtain information quickly, before the patient is taken for diagnostic tests or given medications, which make them drowsy.

"Medical staff will oftentimes interrupt the registration staff or cut them off completely and make them leave the room," says Kimberly Ablog-Shapiro, access representative supervisor for the night shift in the emergency department (ED) at University of California — Davis Medical Center. "Medical staff has a way of making access services staff feel inferior by not acknowledging them," she adds. "Staff complain that they are 'talked down' to, as well."

There is often little to no communication between access services and medical staff, says Ablog-Shapiro, noting that ED registration staff use two computers in each pod to process registrations. On several occasions, registrars left their computers to make a copy or have the patient sign something, and they returned to find a physician using the computer.

"He or she has closed out all of the open windows the registration person was working in, thereby losing all of the information," says Ablog-Shapiro, who adds that this problem occurs even though there are ample computers available for medical staff.

Registration staff sometimes have "extreme difficulty" with social workers when trying to obtain information that identifies an unconscious patient, she adds.

"The worst one, in my opinion, is when bulletins come out about anything to do with the ER. There is never any mention that we are a part of the ER as well," says Ablog-Shapiro. This problem occurs even though access staff work exclusively in the ED and work directly with patients and medical staff, she explains.

"We provide a valuable service to the patients in the community and the entire hospital as a whole, including the flow of patient care, medical records, billing, claims, and clinic referrals," she says.

To correct misconceptions about access, Ablog-Shapiro suggests having medical staff "cross-train" through every aspect of registration, with particular focus on how the beginning of the process affects billing and payment.

"An actual 'cross-training' session might not work because of schedules and how busy the ER is," acknowledges Ablog-Shapiro. "But leaders should provide medical staff leaders a detailed account of everything we have to do, beginning with the patient presenting to the ER and ending with revenue capture."


For more information on misconceptions about patient access, contact:

• Kimberly Ablog-Shapiro, Access Representative Supervisor, Emergency Department, University of California — Davis Medical Center. Phone: (916) 734-3228. Fax: (916) 703-6820. E-mail: