Getting the right people, in the right environment’
First step in improving admissions process
Renovating, reorganizing space, and "getting the right people working in the right environment with the right equipment," all have been part of improving the admissions process at Philadelphia’s Presbyterian Medical Center, says Anthony M. Bruno, MPA, MEd, director of patient access and business operations.
The latest phase of Bruno’s quest to create a brand-new department of patient access and business operations also has included the hiring of a "bed czar" to streamline the facility’s bed management system, he notes. Bruno, who assumed his position in July 2001, is giving Hospital Access Management periodic reports as he works to establish the new department.
"When I came here, I found a situation where a year or two ago, the whole access program was taken apart, and physician offices were asked to do the pre-certification [for physician and hospital services] and then send the information to us," Bruno says. "Our evaluation of that was that it wasn’t working well; they were all doing it their own way. Twenty different [physician] offices were doing the process very differently, with varying degrees of success."
Before admissions manager Karen Randall took the situation in hand, she asked her employees where they saw themselves making the most impact in the department, she explains.
"I sat down with all of them — one on one — and asked them what they like to do and what they do best," Randall adds, "and what they would do if they were in charge."
Sharpening the focus
Focusing on placing the right person in the right job, Randall moved one person from the transfer center, where she had worked with the bed board and bed reservations, to become part of a new group doing pre-certifications and pre-authorization, she says.
The woman, now working at something she considers her strong point, is happy, Randall notes, and the department benefits from the good job she is doing.
That group now performs the pre-certification function for both the hospital and the physician offices, Bruno adds. "[The physician office staffs] have been relieved to no longer be involved. The process was time-consuming and not one they’re particularly trained for. It was mostly done by secretaries who have not had the exposure and training that admission personnel have."
When Randall took over responsibility for admissions, she notes, the department was not doing pre-registration. "I always felt that was the best way to go, so I started a program," she adds. "There is someone calling all the patients, verifying information, and telling them about deductibles and how much money to bring in."
Upon arrival, patients simply sign a form and proceed to their destination, Randall adds, reducing wait time from about 15 minutes to between three and four minutes.
Staffing has been increased from nine full-time equivalents to 12, she says, and beginning in June, the department’s hours were to be extended to 6 a.m. to midnight, seven days a week. Formerly, the department was open five days a week from 6 a.m. to 8 p.m.
There are plans to resurrect the facility’s pre-admission testing program, Randall notes. "I’m meeting with the nurses from the short-procedure unit [SPU] to see if we can schedule those patients in a more orderly fashion."
"We don’t really have a formal pre-admission testing program," Bruno adds, "so the short procedure unit was informally bringing in patients [for the testing]. Now we’re working with the personnel in the lab and SPU to formalize that and make it more organized."
Several months ago, Bruno says, the hospital formed a bed management committee, made up of himself, the medical director and nurse manager for the emergency department (ED), the chief medical officer, and the chief resident for medicine, as well as representatives from nursing and clinical resource management. Out of that committee’s efforts, he adds, came the development of a position called admissions nurse facilitator.
The idea, Bruno explains, was to hire someone with a lot of nursing experience who could take over — and greatly enhance — the responsibilities previously held by an admissions registrar assigned to bed placement.
"In the old process, someone was sitting at a desk in the admissions department doing this," he notes. "Now we have someone who is not only clinically trained, but who is on the spot. [The role] is much more proactive than ever before."
Julie Galen, RN, a nurse who has worked for the hospital for four years, moved from the intensive care unit to become admissions nurse facilitator, says she starts her day by going into the admissions department to find out if any patients are waiting for beds, who on the schedule needs a bed, and to get the names of patients scheduled to come in that day.
After going through the operating room schedule to determine who will need to be admitted after surgery, Galen adds, she checks with the catheterization lab and the ED to see who is scheduled to be admitted after procedures being done there.
"There are some who might be admitted, but [the clinicians] are not sure." Other patients are on a waiting list, she says, including those requesting to be transferred from other facilities. "I take all of the pieces of the puzzle and start to sort."
"After I go to the [bed management] meeting to find out the nurse/patient ratio for the day and to find out what floors are short of nurses, I go to all the floors," Galen says. "I keep a running census and go to the floors on an hourly basis to check discharges."
Before, she notes, the nurse managers would inform admissions staff of discharges at 3 p.m. each after receiving the paperwork. With the new, more proactive process, Galen says, "we don’t get one admission on top of another. As a patient leaves, we get another patient. I’m able to see all the floors, and get a good feel for what’s happening on each floor. I’m able to tell the staffing clerk if we need extra help, so she can call in another nurse."
"The difference is that [Galen] walks the floors," Bruno says. "She is our eyes and ears." One of the other advantages of having the admissions nurse facilitator, he points out, is that she can work more knowledgeably with physicians and nurses to decide bed placement priorities.
Among other improvements, he adds, the ED staff are much happier. "They have someone who goes down and gets a good sense of who’s there. That’s much more difficult for a nonclinician."
[For more information, contact:
• Anthony Bruno, MPA, MEd, director of patient access and business operations, Presbyterian Medical Center, Philadelphia. Telephone: (215) 662-9297. E-mail: [email protected].]
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