Ease the switch to bedside registration

Here’s how to overcome obstacles

Has your ED switched to bedside registration yet? This is without question one of the most effective ways to reduce delays and improve patient flow, but a multitude of obstacles can arise during implementation, says Denise Proto, RN, MS, CEN, nurse educator for emergency services at Gwinnett Medical Center in Lawrenceville, GA.

"Any time a process is changed, it can create chaos and problems," says Proto. "We actually lost a few long-term associates who chose to transfer rather than go through the change of a new way of doing things. But it has worked out in the long run."

Before bedside registration was implemented at Southern Ohio Medical Center in Portsmouth in 1997, average door-to-doctor time averaged 80-90 minutes, which decreased to 37 minutes as a result of the change, reports Mary Kate Dilts-Skaggs, RN, MSN, director of nursing, emergency and outpatient services.

"The patient’s perception is that they are being treated quickly, and that is the bonus," says Proto.

Transition can be slow

However, at Southern Ohio, only 37 registrations were done at the bedside in the first month after the switch, and this number increased to just 87 several months later.

"Most people don’t like change, and there is a learning curve," says Dilts-Skaggs. "Figuring out the bugs is a continuous process."

Currently, the ED does 1,490 bedside registrations per month, which comprises 47% of total registrations. "So it can be accomplished, but it took us a couple of years because of staff reluctance to change," she points out.

To avoid problems with bedside registration, do the following:

  • Have a dedicated ED supervisor of registration.

This individual has a business background and works closely with the ED nurse director, explains Dilts-Skaggs.

"She can work the floor with the registrars, which gives her a lot of credibility," she says.

"The fact that she is a member of the process improvement team is also a major asset," she adds.

  • Be prepared for equipment and software glitches.

"Make friends with information services when you are making a change such as this," Dilts-Skaggs recommends. "Also, we involved them in looking at the wireless computer model." After a trial run with the Point of Care Terminal SC-1000, manufactured by Alton, PA-based Tremont Medical, four workstations were purchased.

  • Ask champions to lead the way.

Ideally, several individuals should be champions of the change, including registrars, nurses, or physicians, says Dilts-Skaggs.

"They can lead by example to show others this can work," she explains. At Southern Ohio’s ED, the champions included the ED registration supervisor, the ED medical director, assistant nurse managers, and an ED nurse.

These individuals made a point of sharing verbal feedback from patients with staff to show that the process change made a difference in the way care was perceived.

  • Have contests with rewards.

At Southern Ohio’s ED, contests were held by nurses to see which shift could do more bedside registrations in a month, and each shift was given a monthly target number.

"You need to celebrate different milestones, such as 100 bedside registrations a month or 1,000 a month," recommends Dilts-Skaggs. "When we hit 700, the entire ED staff was treated to chicken and ribs by the medical director."

  • Combine bedside registration with electronic documentation.

Gwinnett’s ED uses EmSTAT emergency department information system (developed by Cary, NC-based A4 Health Systems) for computerized documentation in addition to bedside registration.

"This allows us access to historical data at the time the patient is triaged, which is a huge timesaver and patient pleaser," says Proto.

  • Obtain buy-in of registration staff.

"Bedside registration certainly creates more problems for the registration staff, so having their support from the beginning is crucial to making it work," she notes.

Since bedside registration previously was implemented at another larger hospital in the system, registration staff from that facility were asked to come troubleshoot during the first week of implementation.

"We did have some issues with the interfaces working correctly for the first few days we went live at our smaller facility," Proto says.

"It helped to have someone familiar with the process to answer questions about inevitable snags and equipment malfunction," she continues.

  • Encourage staff to give input.

A log was created to document questions and concerns about the bedside registration process, says Proto.

"Staff are asked to give suggested changes and are given a resolution date for when the problem is solved or the reason why something could not be done," she says. "That has been a great way to communicate with everyone."

Sources

For more information about bedside registration, contact:

  • Mary Kate Dilts-Skaggs, RN, MSN, Director of Nursing, Emergency and Outpatient Services, Southern Ohio Medical Center, 1805 27th St., Portsmouth, OH 45662. Telephone: (740) 356-8430. E-mail: diltsmk@somc.org.
  • Denise Proto, RN, MS, CEN, Nurse Educator, Emergency Services, Gwinnett Medical Center, 1000 Medical Center Blvd., Lawrenceville, GA 30045. Telephone: (678) 442-4414. E-mail: dproto@ghsnet.org.