Communication greatly enhanced
A new emergency department (ED) tracking and documentation system at The Ohio State University (OSU) Medical Center is enhancing communication between registrars and clinicians and streamlining patient throughput, explains Lisa Siegle, assistant director of patient access services. Registration employees are delighted with the new on-line system, which allows staff to move seamlessly from one area to the other — responding to shifts in work volume — without time-consuming telephone calls, Siegle adds. The overall project, she points out, involves tracking and documenting care throughout the patient’s stay, down to details of charge entry and the monitoring of test and X-ray status.
How the process works
From a registration standpoint, the process begins as follows:
- The ED patient fills out a short form that asks for name, date of birth, and chief complaint, with a box to check indicating gender. Not having the patient give the information verbally is a product of the Health Insurance Portability and Accountability Act privacy concerns, Siegle notes.
- A registrar enters the information into the Ibex PulseCheck system.
- The patient goes to primary triage, where a nurse does a quick overview of the patient’s condition and checks vital signs.
- Depending on the patient’s condition and the wait time, he or she goes back to a treatment room for second-tier, full triage, or to the lobby to wait.
- The results of the triage are entered into the system by the triage nurse.
- When triage is completed, the nurse indicates in the system that the patient is ready for registration. At that point, the name goes to a separate work list of patients who are waiting to be registered.
In the past, Siegle says, the nurse would put the patients’ chart on a rack after triage, and registration staff would pull the charts in order and call patients to come to registration. Now, she adds, registrars take the information off the tracking system and call patients in the order of urgency.
In the back, meanwhile, staff previously would refer to a white board, where a nurse would write the last name of the patient who was in a particular treatment room, indicating a registrar could check with clinical staff. Clinicians might ask the registrar to wait or might indicate it was OK to register the patient.
Now, Siegle says, "we’re not cued until the patient is ready." Rather than place a green "R" on the white board indicating the registration has been completed, registrars now indicate that in the computer. "So now we don’t have to rely on the charts up front, and in the back, all the patients hit our work list [electronically], so we’re not looking at the white board anymore," she adds.
Another advantage is the increased legibility of the on-line listing, which helps with patient identification, Siegle notes. "We still post the tracking board, but we don’t rely on it. It’s an enhanced re-creation of the old white board on a plasma screen that receives a message from the system and populates it," she explains.
Work list keeps staff on track
The electronic work list also is beneficial because staff who are not occupied in the back can see on the computer screen if there’s work to be done in the front, she says. In the past, Siegle adds, "we might have had some employees hanging out in back, not knowing there were a lot of patients waiting to be registered in the lobby. Now they can come out front and help out."
Although the employees always could be summoned with a phone call, Siegle points out, in many cases, the registrars working in front would be looking for a good time to make that call and, instead of making it, might continue to register patients to try to get ahead.
The on-line system also replaces the need for co-workers to check with each other to determine who will go to what treatment room if there is more than one chart up, she says. "If you go to register a patient, you click on a box so that as you sign in, your initials are populated on the screen. The system also puts an icon indicating a registration is in progress."
Again, the same information is replicated on the main tracking board, Siegle adds. "The clinicians can see that we’re registering right now, and that shortly they can start their processes — ordering labs, X-rays, etc. Before, we would often get approached by a clinician who would say, Is so-and-so in Room 5 being registered?’
"They couldn’t tell from the [old] board," she notes, "which only indicated when the registration was complete. So it’s a nice function to see who’s in progress and who’s working on that patient."
When the registration is complete, the registrar clicks on her initials, which drops her off the work list, showing that she is finished. She then takes the next patient, based on urgency, which is indicated in the system by shading.
There are four categories, Siegle explains, with the color black for the most urgent patients, and in decreasing order: red, green, and blue. "If there are two [cases] that are both [category] black, we take them according to length of stay, or the clinician will verbally tell us. For the most part, though, that’s not an issue."
Under the old procedure, however, "we couldn’t see urgency and would be bombarded by clinicians saying, Can you take the patient in Room 5 first?’ because they needed care the most quickly," she says. Thanks to the increased coordination made possible by the new system, Siegle continues, "it’s nice to be working in the same direction as the clinicians."
Training time minimal
On-site training was provided by the vendor, and it took no more than two hours for registration staff to get up to speed on the new system, Siegle says. Although registrars went to two hours of vendor training, she adds, they were grouped in with other staff and probably could have learned what they needed to know in about 30 minutes. Another hour was devoted to operational training. "It also depends how you’ll use [the system]," Siegle notes. "Some facilities have the greet function with the nurse; but our registrars handle the greeting, so there’s a little training there."