EXECUTIVE SUMMARY
Patient access areas can greatly improve relationships with clinical areas by getting involved in organizationwide patient safety initiatives, according to hospital leaders.
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Train registrars to respond if patients need emergent medical help.
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Represent patient access on compliance, quality, regulations, and patient flow committees.
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Cite examples of surgical patients who presented without identification due to lack of clarity by the pre-assessment team.
A patient presents for an outpatient test without any form of identification. He misquotes his date of birth and uses a nickname instead of his real name when giving his information to registration.
This is a common, and potentially dangerous, scenario in registration areas. “Now, more than ever, clinical leaders are seeing that patient access plays a huge part in the success of avoiding patient safety events,” underscores Coleste S. Amerson, CHAM, manager of patient access at Northside Hospital – Atlanta.
In this hypothetical scenario, registrars likely would create a new account and new medical record number, which means care providers wouldn’t be aware of the patient’s medical history or allergies. If the patient was admitted to the hospital and had a contrast dye allergy, the admitting team wouldn’t know about it, which potentially could result in an intensive care unit admission.
In cases such as this, says Amerson, “if the patient had presented with photo ID, it would have been found at that time that he already had a medical record number in the system. His previous medical history and allergies list would have been documented accordingly.”
Immediate care
As the “front door” of the hospital, patient access employees usually are the first people that patients encounter. In some cases, registrars need to do more than schedule or check in a patient; they need to respond to a need for immediate medical care.
“Staff in patient access areas aren’t typically clinically trained, so they need tools to help them recognize and appropriately handle urgent and emergent situations,” says Michele Tierney, revenue stream manager at Seattle-based Virginia Mason Health System.
The patient access team worked with the Primary Care Department to develop Urgent/Emergent Guidelines. Karen Layher, manager of Virginia Mason’s Call Center, says, “Schedulers use this resource to ensure individuals calling to schedule an appointment will be safe until coming in for their scheduled appointment.”
Patient access team members use the tool to direct patients to appropriate care. “These guidelines are used by all staff members who take incoming calls and also by team members at our access points,” says Layher. After hours, hospital operators use the same guidelines to direct patients to providers or nursing resources.
“Patient access staff were involved in creating these guidelines, using the continuous-improvement processes of the Virginia Mason Production System, the organization’s management methodology,” says Layher.
At Washington, DC-based Sibley Memorial Hospital, a stroke coordinator gives a quarterly in-service to registrars on symptoms of stroke and instructs them to call the stroke response line if they suspect a patient might be having a stroke. “Even as a nonclinical department, we can still see the signs. If you are not sure, it’s better to call the number, than not to,” says Katherine Narbonne-Mirchin, MBA, operations manager for the Admissions Department.
Amerson sees a unique role for patient access in patient safety, by serving as the patient’s initial contact. “We have an opportunity to provide the first level of protection against any unfortunate patient safety event,” she says.
Northside’s registration areas clearly post key phone numbers, such as security, so it is easy for an employee to call for help. Amerson says patient access should be prepared to provide a patient with any assistance necessary.
“In an urgent situation, they may need to help stabilize the patient prior to a medical provider arriving,” she says. “This could simply be ensuring all patient access employees are CPR-certified.”
Head off problems
Patient access should participate on any hospital committee centered on compliance with The Joint Commission standards, compliance, regulations, or quality — particularly patient flow or patient throughput, urges Amerson. (See related story later in this issue about patient access’ involvement on patient safety committees.)
Such committees “are a great forum to share any barriers patient access leaders are seeing that relate to patient safety and how those can be a delaying factor when moving a patient through the organization,” Amerson says.
In Amerson’s experience, resistance to patient access being part of clinical meetings and discussions “is almost a thing of the past.”
If patient access leaders do encounter outdated attitudes, it is important to speak up, Amerson adds. “Provide real examples of issues that could have been avoided or caught sooner if patient access was involved,” she suggests.
One common problem is that patients often are told during their pre-assessment call, usually facilitated by the clinical team, not to bring any personal belongings with them when they present for surgery. Some patients take this literally, and don’t bring anything with them, not even a photo ID.
“Patients are, at times, confused during a stressful event in their lives such as major surgery,” says Amerson. When patients present to registration, it is easy for them to misquote a date of birth or even misspell their own names. “Anything is possible when a patient is nervous and not thinking clearly, because they are worried about the test or procedure they are about to have,” says Amerson.
The pre-assessment team should clearly state that the patient needs to present with their photo ID and insurance card if appropriate. “Not presenting a photo ID when presenting for registration could lead to a patient identification issue, which in turn could lead to a patient safety event,” warns Amerson.
SOURCES
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Coleste S. Amerson, CHAM, Manager, Patient Access, Northside Hospital – Atlanta. Email: [email protected].
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Karen Layher, Call Center, Virginia Mason Health System, Seattle. Phone: (206) 341-0664. Email: [email protected].
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Michele Tierney, Revenue Stream Manager, Virginia Mason Health System, Seattle. Email: [email protected].
