Tighter system reduces registration to 6-7 minutes

Physicians’ concerns sparked effort

Registration times for patients at Memorial Medical Center (MMC) in Sioux City, IA, average "six or seven minutes," says Mary Miller, RN, manager of access services.

That includes "anybody who comes in for anything," she adds. "We really work to keep it there."

Although registration times at MMC have been monitored for the past decade, a renewed focus on reducing them began a couple of years ago, Miller notes. "Our access director at the time came to me and said he had committed the department to registering same-day surgery patients in 15 minutes or less."

"The physicians didn’t want the surgery time delayed," Miller explains. "They were extremely unhappy if we were unable to meet table time,’ which is the time they want to actually begin the surgery. We committed to meeting that time."

In the past, she notes, the problem had been that patients occasionally would not be ready at the appointed time, and there would be a "domino effect" that backed up the rest of the day’s procedures."

To facilitate the process for those patients, Miller says, staff put big orange dots on those registrations. "Now we use stars, but it tells us this is a same-day surgery patient and to give that patient priority. We found that when they’re moving through faster, other patients are, too."

Putting a bigger emphasis on preadmission was one key to the reduced registration time, she notes. "The more pre-admit charts we have, the less time it takes."

Designating an access nurse to greet incoming patients, prioritize them, and move them quickly into registration booths also speeds up the process, Miller notes. "[That nurse] is constantly watching [as patients arrive]. We don’t want patients to even sit down in the waiting area if they don’t have to."

To make sure the system works, Miller sits at the registration desk between 6 a.m. and 8 a.m., during the time the same-day surgery patients begin arriving, she notes. "I make sure that as soon as the patient comes in, the next registrar has that patient."

With 150-300 patients a day coming through, it’s important that the first surgical procedures begin on time, Miller says. Registrations for a chest X-ray — which doesn’t have a scheduled time — aren’t as time-sensitive, she adds.

"It’s like having an extra registration booth," Miller says. "I am at the front desk with the volunteer signing patients in. If the booths are full and the patient has a pre-admit chart, I place the face sheet in front of [the patient] and ask if it’s correct. While I’m getting the signature, the volunteer is copying the front and back of the insurance card."

An interesting discovery has been that patients "love reading it," she adds. "They really read it carefully, line by line, and say things like, No, that should be an eight instead of a six in my mother’s phone number.’ It’s their information, and we [traditionally] don’t let them see it."

Regarding the admission of inpatients, Jackson explains, physicians were unhappy that, as a result of data gathering, it was taking a long time to get their patients into a bed. (To see how the facility's triage-to-room time fell dramatically; click here.)

"Part of the problem was slow people in the central registration area," she says. "We made some changes not only in work flow, but in the area itself. We have done major renovation and remodeling in the past two years."

The registration booths, which before could not be easily accessed by a person in a wheelchair, have been put in a different configuration and are more user-friendly, Jackson says. The new arrangement also is more conducive to patient privacy, she notes, which was a major emphasis in the redesign.

About four years ago, Jackson says, the hospital developed a revenue cycle system that has provided the framework for the recent improvements. Included in that system, she adds, are patient financial services, which comprises admitting and registration, clinical information systems (medical records), and case management services.

A recent report from the National Registry of Myocardial Infarction reveals another impressive statistic to which registration efforts have contributed, Miller points out. MMC’s "door-to-dilatation time" — the time between a patient’s arrival at the hospital and inflation of the balloon for a primary angioplasty procedure in the cardiac catheterization lab — is 69 minutes, she says. "The average in Iowa is 94 minutes, and the national average is 104 minutes."

Registration plays a part in that figure, Miller notes, "because registration doesn’t hinder or delay [the process] in any way, yet it’s done so the record is there."