EXECUTIVE SUMMARY
Patients arrive an hour closer to surgery due to a revamped registration process at Lakeland (FL) Regional Health Medical Center.
- One hundred percent of surgical first case patients are contacted prior to service.
- Physicians’ offices quickly assist with insurance issues.
- The family can track the patient’s location via an electronic bed board.
Due to a revamped registration process, surgical patients at Lakeland (FL) Regional Health Medical Center now arrive two hours prior to surgery, instead of three.
“We were challenged by organizational leadership and our patients, via patient survey results, to decrease the hours that our patients waited to be processed when presenting for surgery,” reports Jane A. Dyer, CHAM, CRCE-I, manager for patient access services.
Patient access leaders attended all meetings of the Surgical Services Redesign Committee, which also included nurses, technicians, information technology analysts, industrial engineers, and physicians. “We provided input regarding all of the current processes, not just those related to patient access,” says Dyer. Using Lean Six Sigma principles, patient access studied these processes:
- Patient access reviewed every step involved when a patient presented to the admissions department, from the door to the perioperative unit.
- The pre-processing team reviewed the available surgical scheduling reports. They analyzed how the first and second case patients could be identified and then contacted, to verify information and secure authorization for service and collection prior to service.
“We looked at things from a patient’s perspective, as though we were the ones actually going through the process, from check-in to arrival in the OR,” says Dyer.
First Cases Contacted
Deborah L. Newbern, CHAM, CRCE-I, assistant director of patient access services, explains, “The goal was to improve the patient experience by improving admission and wait times for our surgical first cases.”
Previously, patient contact wasn’t always prioritized before the time of the patient’s surgical case. “Patient contact for insurance and other preprocessing information often took place on the scheduled date of service,” says Newbern. This process caused delays on the date of admission for first and second surgical cases.
Now, the preprocessing team makes a focused effort to contact patients scheduled for the first or second surgical case. Dyer says, “Since the inception of the new process, 100% of surgical first case patients are contacted prior to service. For all other cases, the team has reached an 85% contact success rate.”
When roadblocks such as lack of authorization or other insurance issues occur, physicians’ offices are quick to assist. “For example, if a physician’s office cannot secure insurance authorization due to extenuating circumstances by 9 a.m. the day prior to the patient’s procedure, some flexibility has been built into the process,” says Dyer.
This process gives the physician’s office staff a little more time to get the insurance company anything that’s holding up the authorization. “If everything has been submitted and authorization has not been secured by 4 p.m., the patient’s case will be rescheduled,” says Dyer.
Two-Hour Arrival Times
The new process achieved immediate results.
Newbern says, “Patient arrival times were shortened from three hours to two hours. The registration process now takes just a few minutes to complete.”
These steps occur when the patient arrives two hours before surgery:
- Patients have a quick check-in at the surgical waiting desk.
- The family is provided with a number to track their loved one from check-in to the postanesthesia care unit, via electronic bed board. “The number is displayed, so the family can see where their loved one is at any given time during the surgical visit,” says Newbern.
- The patient is taken directly to his or her preoperative room.
- Patient access does bedside registration and secures electronic signatures.
“Our patient access representatives are thrilled to be using cutting-edge equipment to complete patient registration,” says Newbern.
To shorten registration times, some registrars had to work different hours. Rather than having most come in at 4 a.m., only a few team members come in at 4 a.m. to have the perioperative area readied to receive patients. Patient access managers then use staggered shifts to cover the rest of the department.
“By using staggered shifts, we are better able to accommodate the needs of our patients,” says Newbern. “The change in hours has also improved satisfaction among our team members.”
Registrars were not accustomed to working at the patient’s bedside, but they were enthusiastic about the new process. “Once the process started, the team was excited to see that, with the registration completed, the patient was in their bed and ready for the next step in the process,” says Newbern.
SOURCES
- Jane A. Dyer, CHAM, CRCE-I, Manager, Patient Access Services, Lakeland Regional Health Medical Center, Lakeland, FL. Phone: (863) 687-1193. Email: [email protected].
- Deborah L. Newbern, CHAM, CRCE-I, Assistant Director, Patient Access Services, Lakeland (FL) Regional Health Medical Center. Phone: (863) 284-1788. Email: [email protected].
