Hospital leads trend of nursing in access
Hospital leads trend of nursing in access
It only makes sense’
If more nursing expertise in the access department is the way to go, St. Joseph’s Hospital in Atlanta has a head start. Overseeing the department are two registered nurses — the manager for patient access services and the manager for nursing support services — who report to the director of nursing administration.
"With RNs making up 75% of our hospital employee base, it only makes sense for an RN to lead the access management team because it plays such an integral part in the patient accessing the hospital system," explains Stephanie Holland, RN, CHAM, the manager for patient access services.
Holland oversees the hospital’s cashiers, registrars, financial counselors, insurance verifiers, and an education specialist. Her colleague, the manager for nursing support services, is in charge of patient placement, central scheduling, and case managing transfers into the hospital, she adds. Their boss, Kim Sharkey, RN, MBA, CNAA, reports to the hospital’s chief nursing officer, who also is vice president for operations.
"The whole admissions department used to fall under the business office," says Sharkey. "We found that if we could put the front-end processes and nurse staffing in one area, under nursing, we’d know where the patients are coming in, where they’re going, how we would staff for them, and how they would pay."
It works well, she explains, because access personnel can determine immediately which bed a patient will occupy and what staffing will be necessary. "Central scheduling [personnel] can say, We have an urgent patient coming in. We need a bed in the intensive care unit [ICU],’ and [the nurses] know what kind of questions to ask. Because we are nurses, we also know physician preferences. We know the physician prefers the patient on this unit rather than that unit, and it saves a lot of frustration."
As a nurse who has worked on the floor and in the ICU, Holland points out, she is equipped to view the patient’s care globally, "from clinical to nonclinical and from the financial perspective. We see the whole picture from admission to discharge, and we can help initiate that process a bit better."
Having a nurse who understands physicians’ orders and instructions and who works with physicians to expedite the admission of a patient makes the access process go more smoothly, she says. The manager for support services, Holland notes, "really is a liaison between the hospital and the physician’s office in placing the patient appropriately."
Directing patient traffic
About 60% of St. Joseph’s patients are urgent direct admits from outlying facilities, and her colleague case-manages those patients who are directed to a hospital room, the catheterization lab, or the operating room, she says. "He talks on the telephone all day long, placing urgent direct admits from across the state of Georgia and expediting transfers."
The manager for support services prevents delays in getting care for patients, she adds, at times printing out the blue patient stamp plate and the armband for the operating room nurses when an admit is going directly to the OR.
Nursing expertise also comes in handy, Holland says, in understanding what insurance companies will cover with regard to patient type. "If a physician wants to admit a patient who is in need of a heart catheterization, we will give that patient ambulatory status to begin with, then oversee that whole process and upgrade the status [to observation or inpatient] if necessary."
If the patient isn’t upgraded, the insurance company won’t reimburse at the proper level, she says, and it’s time-consuming to change status back to ambulatory if the patient does not meet the observation or inpatient criteria.
In the area of financial planning, Holland says, her nurses’ empathy for patients comes into play, complementing St. Joseph’s philosophy of charity care. "We refer to it hospitalwide as the financial continuum, knowing how important the care continuum is clinically," she explains. "We have a nursing care plan, and we have somewhat of a financial care plan. The whole access management system is part of the financial continuum, which overlaps with the patient care continuum.
"We want patients to be mostly concerned with getting better," Holland says, "and we’re here to help them give that the priority."
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