Bedside Registration Best for Patient Flow, But the Process Needs Fine-Tuning

Bedside registration has been in place for more than 20 years in the ED at William Beaumont Hospital Royal Oak (MI). However, the process has changed many times in recent years.

“While this model is, by far, the best for our patient care flow, it has presented our staff with challenges from a registration perspective,” says Cheryl L. Webster, director of patient registration and hospitality services.

The ED sees about 350 patients a day. “In an ED our size, every step and every keystroke saved can really improve flow,” says Webster. Here are some recent changes made to the bedside registration process:

• Registrars are located at the front and back entrances to quickly perform a “mini-reg.”

Registrars select the correct patient from the master file and place an armband on the patient. “This is especially important when patients need to go straight to the OR or cath lab,” says Webster. “They are sent to those locations with a visit on the system and armband already in place.”

• Small scanners were added to the wheeled workstations.

“We can quickly scan driver’s licenses and insurance cards to use later as needed,” says Webster.

• Staff tested wheeled carts to find ones that were easy to manipulate.

“We had the vendors provide us with temporary carts for our staff to ‘test drive’ and vote on their favorites,” says Webster.

Some of the carts were heavy or difficult to turn; others had wheels that slid smoothly over bumps. “The cart shape made a difference in how they fit into some of our tight spaces,” adds Webster.

The project took a year to complete because staff tried one cart at a time. Some staff members were slow to email supervisors with their opinions. “The supervisor really had to stay on top of this project, so someone was using the test carts and giving feedback,” notes Webster.

• A “floating registrar” covers registrars during breaks and areas with sudden surges of patients.

• Supervisors and trainers do more frequent performance reviews to see if new hires are having difficulty with bedside registration.

“Our existing staff indicated that some new staff with performance challenges were not having their probation extended,” says Webster.

Supervisors use a specific performance rating tool to assess how new hires are doing with the bedside registration process. [The checklist used by the department is included in the online issue. For assistance accessing your online subscription, contact customer service at (800) 688-2421 or [email protected].]

“Some staff were a bit clumsy with the interview process: how to probe for more information, how to stay organized during the chaos of a Level 1 Trauma Center,” says Webster. Most new hires don’t have any background in insurance or registration, so they need some extra coaching. “Most often, our new staff are surprised by the level of detail involved in a registration interview,” says Webster.

Constant Communication

“Constant communication” between patient access and clinicians keeps patient flow moving in the ED at Ottawa, IL-based OSF Saint Elizabeth Medical Center, says patient access manager Kaylyn Lambert.

“If a patient’s issue worsens, staff will work together to get that patient back to a room, with the registration completed at the bedside,” says Lambert. Here is how the department keeps its bedside registration processes running smoothly:

• During times of high volume, patients are continually monitored and communicated with regarding their wait times.

“This includes wait times to see the provider as well as any wait for any testing or results,” says Lambert. “This has been a huge improvement.”

• The ED is staffed so that registrars are available for booth registrations as well as bedside registrations.

“This allows us to make sure our portion of the patient’s visit is complete as soon as we are able to register the patient, dependent on their status,” she says.

• Registrars check in with patients at the bedside.

“We do this often, to see if the patient and/or their families need anything,” says Lambert. (See related story in this issue on a department’s one-stop process for bedside registration.)

SOURCES

• Kaylyn Lambert, Patient Access Manager, Revenue Cycle, OSF Saint Elizabeth Medical Center, Ottawa, IL. Phone: (815) 431-5482. Email: [email protected].
• Cheryl L. Webster, Director, Patient Registration & Hospitality Services, William Beaumont Hospital Royal Oak (MI). Phone: (248) 898-0860. Email: [email protected].