OP flow coordinator has unexpected benefits
Patients get closer attention
Adding a coordinator to help regulate the flow of patients to registrars in the outpatient registration area has played an integral role in slashing wait times at the University of Pennsylvania Medical Center-Presbyterian in Philadelphia, says Raina Harrell, CHAM, director, patient access and business operations.
The flow coordinator position — one of seven parts of an action plan aimed at reducing patient wait time — has led to improved communication between registrars and ancillary departments, virtually eliminated lines at the reception desk, and improved the outpatient operation in ways that were not even anticipated, Harrell adds.
"We identified that patients who were in the wrong area or needed to be directed to another area were presenting to the outpatient receptionist," she explains. "There were others who weren't prepared — who didn't have a referral, didn't have a [physician order], and were not even sure what test they were having performed."
The access management team determined that a flow coordinator was needed to address those problems and that the position didn't need to be full-time, but should cover the area's busiest times, which are 9 a.m. to 1 p.m. Monday through Friday, Harrell says.
Because the position was filled by an existing registrar — who returns to his registrar duties after 1 p.m. — there was no increase in full-time equivalents (FTEs), she notes.
"We bought a podium so that paperwork wasn't visible to patients, and gave that person the schedules for the day and a 'zone phone' [for interhospital communications]," Harrell says. "We informed the physician practices and ancillary areas that we had this person, and gave that zone phone number as the point of contact."
The stated purpose for the new position, she says, was to facilitate communication between central registration and the physician practices so that patients could arrive at their ancillary appointments in a timely fashion.
"Our initial target was to reduce wait time," Harrell continues. "Instead of a sign saying, 'Have your referral and your insurance card ready,' there is now a person saying, 'Do you have your insurance card, your identification, and your [order] for the test you're having? Please have that ready for the registrar.'"
The flow coordinator is able to prescreen patients before they reach the receptionist desk and find out, for example, that a patient is covered by a payer that requires a referral for outpatient tests, and the person does not have the referral in hand, she says.
"If the patient doesn't have a [physician order]," Harrell adds, "the flow coordinator can get on the phone and see if it can be faxed over before the patient sits down with a registrar so there is no delay."
The receptionist signs in patients and lets registrars know they have arrived, but can't do any investigative work, she notes. That means that before, the first time registrars realized something was missing was when the patient sat down to be registered, Harrell says.
The new position has been of particular help to the high-volume radiology department, she points out. If staff there are looking for a patient who is late, they can call the flow coordinator and ask if the person is in the lobby.
"This became a tremendous benefit for us," Harrell adds. "If Patient X arrived late and Patient Y was early, we can have a proactive conversation about sending [the one who's ready] to the department.
"In the past, they would have called registration and a registrar would have had to stop registering another patient and answer the phone and figure out if the patient they're asking about is there," she says.
'The waiting room was clear'
The registrar, who serves as flow coordinator, happens to be a man, and by his own choice wears a suit to work, which, Harrell says, adds a certain aesthetic quality. "There is a man in a suit out in the lobby, walking around greeting patients."
After the flow coordinator began doing his job, Harrell discovered an unexpected benefit.
"All of a sudden the waiting room was clear," she notes. "I didn't know why, but the staff did. Patients used to just sit back down [after registration], rather than going on to their appointments."
While in some cases these patients might have been waiting for someone to tell them to report to the ancillary department, Harrell says, in other instances it had to do with the penchant many elderly patients have for arriving as much as two hours early for their appointments.
"If they arrive at 7 a.m. for a 9 a.m. appointment, then they do need to sit back down," she adds. "Then they might forget the time and end up being late."
Now the flow coordinator is on hand to notice that someone has been sitting too long, and to ask if there is a problem, Harrell says. "The coordinator can also let patients know about delays, and if someone needs a wheelchair, go and get it."
If a registrar determines that the person he or she has just registered needs an escort to his or her appointment, the flow coordinator also can take a few moments to provide that service, Harrell notes.
The flow coordinator position, which was established in February, was one piece of the initiative aimed at reducing outpatient registration wait time, Harrell explains. That effort, which took place within the fiscal year that ended June 30, also included the following improvements:
- Benchmark wait times of 20 minutes for non-scheduled patients and 15 minutes for scheduled patients were established.
- A "red flag" process was created, whereby someone alerted the rest of the staff if a patient's wait time went over 30 minutes.
In such cases, Harrell notes, additional staff were called in from other areas to assist in registration.
- The target was established of having 100% of scheduled patients preregistered at least 24 hours before their appointment.
- The access department worked with orthopedics — one of the major ancillary areas — to establish proactive communication of insurance information.
Within that patient population, Harrell explains, there is a large number of workers' compensation and automobile accident cases. Delays had resulted, she says, because the only way to verify those kinds of insurance is by telephone.
To prevent those delays, Harrell adds, orthopedic staff now send over the insurance verification information — which they already obtain anyway — along with the referral and physician order.
- A point-of-service registration area for scheduled services was established for radiology.
Because of the high patient volume in that area — due to MRI and CAT services — a registrar is stationed there, she notes.
Patients are told during preregistration to report directly to radiology, Harrell says, and if there is any confusion, the flow coordinator provides assistance.
- A weekly report regarding wait time and high-risk (any patient who waits more than 30 minutes) cases is created on a weekly basis.
The outpatient registration supervisor, the access manager, and assistant director, along with Harrell, meet each week and evaluate the report.
"Before the meeting, the manager [writes an explanation] of why each patient waited — for example, because it was a high volume time, they were awaiting a referral or there was an issue with insurance verification," Harrell continues. "We look at each case and determine what to do so that it won't happen again."
By the end of June, she says, average wait time had been reduced from more than 30 minutes to 10.5 minutes for non-scheduled patients and 8.6 minutes for scheduled patients.
Harrell attributes the project's success to the identification of a target and "outside the box" thinking on the part of each member of the access management team. "We all worked together to make it happen, and we exceeded our expectations."
[Editor's note: Raina Harrell can be reached at (215) 662-9295 or [email protected].]
Adding a coordinator to help regulate the flow of patients to registrars in the outpatient registration area has played an integral role in slashing wait times at the University of Pennsylvania Medical Center-Presbyterian in Philadelphia.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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