Executive Summary
Lengthy registration times, lack of understanding about why information must be verified, and failure to obtain required authorizations causes other hospital departments to become dissatisfied with patient access.
• Work together to service patients who show up at the wrong location.
• Obtain required authorizations for diagnostic tests prior to the patient’s arrival.
• Explain to emergency physicians why discharging patients without registration causes problems.
Long registration wait times don’t just annoy patients; this frustrating problem can wreak havoc with a clinical area’s schedule.
“If the other department does not fully understand why patient access has to verify information each time the patient walks through the door, it will cause them to think negatively about our department,” says Jordan Martin, corporate educator for patient access services at Spartanburg (SC) Regional Healthcare System.
Here are some approaches to increase satisfaction of other hospital departments:
• Work together if patients show up at the wrong location.
Previously, if a patient showed up at the wrong location at Bronson Methodist Hospital in Kalamazoo, MI, clinical staff simply sent the patient to the correct location.
Patient access manager Karen Garrison says, “Registration and clinical staff worked together to come up with a formal process change to better service the patient.” If members of the registration staff see that a patient they’re checking in is scheduled at a different campus, they call the department and explain the situation. Clinical areas make every effort to perform the procedure where the patient is located.
“In the current model, 99% of the time, the department can accommodate the patient and work them into their schedule,” says Garrison.
• Explain the role of patient access to other departments.
“A large part of our job is to educate all areas of the hospital, whether inpatient or outpatient, on what Patient Access Services does every day,” underscores Martin. “We have taken multiple steps to ensure other departments understand why we do what we do.” Recently, patient access leaders invited technologists into registration areas so they could see the day-to-day operations within the department.
“It is a common thought that registration is an ‘easy’ process and that shouldn’t take long at all,” says Martin. “Other areas do not understand all we have to do on the patient’s account before they are taken back to their area.”
Each area was concerned only about their patients.
“If their patient was a few minutes late, they have called in the past to ask if we could get them back to them as soon as possible,” says Martin. Registrars explained to technicians that patients are registered for all areas — CT, MRI, interventional radiology, endoscopy, laboratory, and X-ray — based on the patient’s arrival time.
“If their patient shows up late, we aren’t going to skip the patients who arrived on time or early for their procedures,” explains Martin. Patient access managers sometimes provide check-in times and registration start and end times for specific patients. This step shows technicians that staff are processing registrations as efficiently as possible.
At a recent meeting, providers asked that Pap smear results be returned to them within 24 hours. “We had the privilege of walking through the process a Pap smear goes through in order to get accurate results to the provider,” says Garrison. Patient access is responsible for making sure there is a complete order and that the specimen is registered.
Providers were amazed at how extensive and involved the process is. “They saw why it is so important that each area works efficiently with one another so all pieces can be completed,” says Garrison. Providers learned that it is very important to have a complete and accurate order form on the patient. “If the order is missing data, the turnaround time will suffer,” explains Garrison. “The process has to stop as we reach out to the physician for further information.”
Problem in the ED
Emergency department (ED) physicians sometimes discharged patients before patient access had the opportunity to register them, and they had no idea of the problems this caused. “This created confusion from all sides,” says Martin.
ED patients are given a “quick registration,” but registrars later complete a full registration at the bedside. Sometimes, patients are discharged before this full registration occurs.
“When physicians beat us time-wise treating the patient and let them leave before we had a chance to speak with them, it took a lot of time on the patient access side to fix this problem,” says Martin.
Patient access managers met with the ED physicians to explain how the process worked. “Now the physicians know that they must have a fully registered account before the patient leaves so that all the departments — medical records, coding, and billing — are able to complete our part of the process,” says Martin.
• Pre-register patients before procedures.
Patients occasionally presented for MRIs who had contraindications for the procedure or who were without required authorizations. This problem caused the test to be cancelled or rescheduled. Spartanburg Regional’s registrars now pre-register and pre-screen all MRI patients, and all pre-certifications are obtained before the patient arrives.
“This has greatly improved the tension between our MRI and Patient Access Departments,” reports Martin. “They now have a great working relationship.”
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Karen Garrison, Patient Access Manager, Bronson Methodist Hospital, Kalamazoo, MI. Fax: (269) 341-7370. Email: [email protected].
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Jordan Martin, Corporate Educator, Patient Access Services, Spartanburg (SC) Regional Healthcare System. Email: [email protected].
