Include access in survey preparation
Executive Summary
Patient access leaders should expect surveyors from The Joint Commission or the Centers for Medicare and Medicaid Services (CMS) to interact directly with front-line staff in registration areas.
• Patient access areas aren’t always included in patient tracers conducted by organizations.
• Registrars might be asked what they do to protect patients’ privacy.
• Requirements for physician orders, staff competency, and patient identification all involve patient access areas.
Patient tracers often leave out registration areas
During a recent survey by The Joint Commission at OSF St. Joseph Medical Center in Bloomington, IL, surveyors asked emergency department (ED) registrars how they communicate with patients who don’t speak English.
"Staff responded very appropriately about using the InDemand video remote interpreting services," reports Gail Scoates, BSN, MSN, RN, regulations and standards coordinator.
Next, surveyors asked ED registrars to demonstrate how they routinely conducted their patient interviews in treatment rooms. "The surveyors then discussed safety issues and provided safety pointers," says Scoates. Here are some things surveyors told ED registrars:
• Always put yourself and the computer between the patient or family and the door, so you always have an escape route.
• Do not go into a room and close the door behind you.
• Never go into a room if you fear for your safety.
• It is OK to ask for help or to ask persons to leave.
Often left out of process
Patient access areas are often not included in survey preparation to the extent they should be, according to Scoates.
For example, organizations don’t always include registration areas in "patient tracers" done as part of survey preparation. "I am afraid we have not involved these areas as much as we should," she acknowledges. "There are times when they are included in tracers just because they are there.’ We only think about these departments as we are touring the medical center."
Since surveyors are likely to visit registration areas, patient access employees certainly should be included in survey preparation, says Scoates. "It truly is very simple. It is just a matter of being mindful," she says.
While patient access areas obtain general education provided by the organization on The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) surveys," they’re likely not included as much as they should be," says Scoates.
She recommends patient access leaders take these steps to prepare employees for surveys:
• Know which CMS and Joint Commission standards apply to registration areas.
"Requirements involving physician orders, staff competency, and confidentiality all involve patient access areas," says Scoates.
• Review department and institutional policies with patient access staff.
"Validate that they know where to locate them," says Scoates.
Do focused preparation
As chair of the National Association of Healthcare Access Management’s (NAHAM’s) Government Relations Committee, Michael Sciarabba, MPH, CHAM, heard from many patient access professionals that they felt unprepared for surveys and audits.
"Patient access is often overwhelmed with how to prepare for what can be a complicated and stressful event," he says.
Sciarabba, director of patient access at University of California, San Francisco, oversaw NAHAM’s development of toolkits for patient access to use to prepare for the Joint Commission and CMS surveys. (See resource at end of this story for more information.)
Patient access managers and front-end staff can use the toolkit’s checklists and question sets to prepare. "Often, patient access staff are prepared. But they don’t have the confidence to respond to surveyor questions," Sciarabba explains. "The goal is to achieve a state of constant readiness, instead of just reacting."
Hospitals often focus on patient safety with survey preparation, and patient access is "kind of an afterthought," says Sciarabba. "But it’s critical, because every patient encounter starts out with patient access."
Patient ID is focus
Patient access areas are directly involved in compliance with patient identification standards, emphasizes Angela Click, patient access services manager at OSF St. Joseph Medical Center. (See related stories on patient privacy questions surveyors might ask, p. 104, and other questions surveyors might ask in patient access areas, p. 104.)
When asked about this area during a survey, Click says her patient access employees can inform surveyors that they take these steps:
• All outpatients presenting to registration are assigned armbands with their names and dates of birth.
• Once the patients present to their testing departments, then the departments verify the patients from their armbands.
"However, the correct armband information must start in registration," says Click. "We use key identifiers to make sure we are registering the correct patient."
• Patient access staff members ask for government-issued photo identification, ask patients to spell their names and provide their dates of birth, and verify the last four digits of their social security numbers.
"This helps to ensure we are registering the correct patient every time," says Click. "Other departments rely on registration getting the identification correct, so they can perform the correct tests."
- Angela Click, Patient Access Services Manager, OSF St Joseph Medical Center, Bloomington, IL. Phone: (309) 665-4817. Fax: (309) 665-5011. Email: [email protected].
- Michael Sciarabba, MPH, CHAM, Director, Patient Access, University of California, San Francisco. Phone: (415) 353-3825. Email: [email protected].
- Gail Scoates, BSN, MSN, RN, Regulations and Standards Coordinator, OSF St. Joseph Medical Center, Bloomington, IL. Phone: (309) 662-3311 ext. 1320. Fax: (309) 661-8421. Email: [email protected].
- * Toolkits to help access leaders and frontline staff prepare for Centers for Medicare & Medicaid Services and The Joint Commission surveys are available at no charge to members of the National Association of Healthcare Access Management. To access the tool, go to www.naham.org and click on "Government Relations" and "Joint Commission Survey Toolkit" or "CMS Survey Toolkit."
