EXECUTIVE SUMMARY
About 13% of patient identification errors involved registration, according to the ECRI Institute PSO’s recent “Deep Dive” report, which analyzed 7,613 cases of wrong-patient errors. Some recommendations for registration:
- Utilize biometric technology;
- Track duplicate and overlaid records;
- Clearly define registration policies and procedures;
- Include staff feedback in quality assurance.
A patient had a do-not-resuscitate order on file, which clinicians followed. However, the patient in cardiac arrest was a different patient, who was incorrectly identified — and not resuscitated.
Another patient was discovered dead in his hospital room after undergoing surgery, but clinicians made the decision to proceed with the surgery based on the wrong patient’s records.
“If we can improve the patient identification process, it will help prevent many different kinds of medical errors that currently plague healthcare delivery,” says William M. Marella, MBA, MMI, ECRI Institute executive director of Patient Safety Organization Operations and Analytics.
In its recent “Deep Dive” report on patient identification, the ECRI Institute Patient Safety Organization analyzed 7,613 cases of wrong-patient errors at 181 healthcare organizations from January 2013 to July 2015.
“Patient access may not realize that the accuracy of their work can impact decisions made by the healthcare team,” Marella says. About 13% of patient identification errors occurred during registration. Some examples:
- A woman was admitted under her son’s name, date of birth, age, and Social Security number.
- While reviewing surgical orders, clinicians realized a patient was registered under the wrong medical record number. The other patient had the same first and last name, but a different date of birth.
“A call to admissions confirmed the patient was registered under the incorrect medical record number when blood specimens were drawn,” Marella says. A new type and screen specimen had to be drawn under the correct medical record number before surgery could proceed, delaying the patient’s surgery.
- Clinicians received an email from a doctor’s assistant requesting a patient be marked as deceased.
“The patient was identified as expired in the EHR,” Marella says. “In reality, the patient had been registered under the wrong medical number.”
A week later, the patient arrived for an appointment, and was shocked to learn of the error.
“Seven outstanding appointments had been cancelled,” Marella says.
False Information in System
Correctly matching each patient with the care providers intended for them is a very basic requirement of safe healthcare, says Marella, “but we saw thousands of events in which that standard wasn’t met.”
Errors made in registration or scheduling follow the patient throughout his or her hospital stay. Marella gives these examples:
- If the patient’s identity isn’t correctly confirmed at the point of care, the patient could receive another person’s medications or undergo an invasive procedure intended for someone else.
- If someone places a positive lab test in the wrong patient’s chart and then another person acts on that test, a diagnostic error can be made.
- If a duplicate record is created for a patient, his or her medical history and test results aren’t available.
“If a patient gets admitted under someone else’s record, it can have disastrous consequences if clinicians trust and act on false information,” Marella adds.
- If information used to identify the patient is entered incorrectly, this undermines the clinical team’s ability to confirm the patient’s identity when delivering medications or performing lab or imaging tests.
“Many admission/discharge/transfer systems require exact matches when searching for existing patients,” Marella notes. “Many older systems do not bring back close matches in addition to an exact match when searching patient records.”
Pitfalls of ‘Quick Reg’
Edward Din, director of patient access at Kern Medical in Bakersfield, CA, recently pinpointed the cause of many potentially harmful registration errors: Non-patient access personnel had completed a “quick reg.”
“Inconsistent patient identification leaves the organization vulnerable to patient complaints from incorrect billing to identity theft, not to mention healthcare-related risks of treating the ‘wrong’ patients,” Din says.
These registrations often require re-work to complete missing data elements. Registrars sometimes call ED patients post-discharge to obtain correct information. “Left unedited, these accounts can show up on the discharged/not final billed report,” Din explains.
The department recently discovered that an average of 99 accounts each month in 2016 on the discharged/not final billed report were attributed to bad registrations, totaling $378,000 of potential lost revenue.
“There is a need to minimize registration errors and their impact on our patients and the revenue cycle,” Din says.
Kern Medical Center’s patient access department made these changes:
- Non-registration personnel are no longer able to access the registration and scheduling applications unless they have been validated as competent. (Editor’s Note: The department’s Patient Access Service Representative Unit Specific Orientation Checklist is included with the online edition of this issue. For assistance accessing your online subscription, contact customer service by email at [email protected] or by phone at (800) 688-2421.)
- A “quick registration” process is still used, but it’s limited to the ED, trauma, and labor & delivery. “Previously, it was also used in correctional medicine and for lab specimen drop-offs,” Din notes.
- Registrars compare the patient’s government-issued ID to any forms completed by the patient during registration. “This ensures the ‘right’ patient encounter,” Din says.
- Training was provided to medical assistants in clinics, appointment schedulers, unit clerks in labor & delivery, and office assistants in correctional medicine. “This includes competency to use our biometric application to scan the patient’s index finger as a method of personal identification,” Din says.
REFERENCE
1. ECRI Institute PSO Deep Dive: Patient Identification (Volume 1). Plymouth Meeting, PA. August 2016.
SOURCES
- Edward Din, Director, Patient Access, Kern Medical, Bakersfield, CA. Phone: (661) 862-4901. Email: [email protected].
- William M. Marella, MBA, MMI, Executive Director, Operations and Analytics, Patient Safety, Risk and Quality, ECRI Institute Headquarters, Plymouth Meeting, PA. Phone: (610) 825-6000 ext. 5173. Fax: (610) 567-1299. Email: [email protected].
Four Recommendations to Avoid ID Errors
In its recent “Deep Dive” analysis of patient identification, ECRI Institute’s Patient Safety Organization provided these recommendations for registration areas:
- Consider supplementing the registration process with biometric methods to improve patient identification;
- Foster a work environment that supports registration staff and values their contribution to patient safety through accurate patient identification;
- Implement a quality assurance plan, using metrics such as duplicate record and record overlay rates;
- Use clearly defined policies and procedures for registration.
Registration errors may have 'disastrous consequences' for patients.
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