Seamless registration process at bedside is what patients want in the emergency department

Patient satisfaction scores for registration areas at WellStar Paulding Hospital in Hiram, GA, are typically in the top 90s, but this score is a bigger challenge in the emergency department (ED) setting.

“When you look at ED registration across the nation, satisfaction lingers around the 50th and 60th percentile. We are way ahead of the curve,” reports Guillermo Sanabia, director of patient access services. For the past year, the ED’s satisfaction scores have been in the 80th percentile or above. Sanabia attributes this score in part to cross-training of registrars in areas such as outpatient, ED, and surgery.

“The cross-training depends on what we envision for the candidate and what we see them developing toward,” says Sanabia. “We found that some people who worked in outpatient registration did better as ER registrars, and vice versa.”

This system allows patient access managers to move registrars who were best-suited for the challenging ED setting to that particular role. “Some of the characteristics we look for in ED team members are personal drive, ability to work independently, ability to collect, ability to work at a high pace, and a pleasant personality,” says Sanabia.

Sanabia is developing a protocol to improve the customer experience in the ED.

“We are not what the patient came to the ED for,” he says. “They could care less about giving us all their demographic information, unless you help them understand that the information we collect will be used for follow up on their care as needed.”

Patients really dislike being asked the same questions multiple times, such as “Why are you here?” and “Was the injury a result of an accident?” “Patients get asked the same questions five or six times by the front desk, the nurse, the doctor, and the registrar. We are trying to minimize that,” Sanabia says. Nurses need the information for clinical reasons, but registrars need the same information to know what occurrence codes to use and to understand the patient’s coverage and financial situation.

ED patients already are not feeling well, and they appreciate registration being completed at the bedside where they’re more comfortable. Patient access manager Wanda Ballew adds, “Most people do not like to answer the questions when there are a lot of people around, especially insurance information and when we are asking for money.”

Often, though, registrars have to leave the room before the patient’s registration is complete. “Patient access is routinely asked to step out of the room,” says Sanabia. “Most of the time, that is not really based on the patient’s need for privacy, but more so because of the relationship between the nurse and the registrar.”

If the registrar and nurse are entering the room at the same time, the nurse usually asks the registrar to step out of the room. “In reality, there may be no need for us to step out for that particular encounter, and we can benefit from the initial interview by the nurse,” says Sanabia. The protocol she is developing sets criteria for when registrars should be asked to step outside the room: if patients are physically exposed, if sensitive information is being discussed, or if patients are uncomfortable having the registrar in the room.

“We are going to introduce the protocol when onboarding new hires and at staff meetings, so everyone knows what to expect,” Sanabia
says.