Dedicated ED registrar streamlines operation
Outpatient wait times reduced
When an infusion of radiology patients into the central registration process at Ridgecrest (CA) Regional Hospital led to longer waits and outpatient complaints, admitting/communication team leader Monika Lenz, CHAA, knew it was time for reorganization.
Her solution — dedicating one employee to perform emergency department (ED) registration — not only has dramatically shortened wait times, but has streamlined the jobs of both outpatient registrars and ED clinicians, she reports.
Incorporating radiology patients into the general outpatient mix was done out of necessity about a year and a half ago, Lenz explains, because of space constraints in the radiology area. When the outpatient staff took over the registration of those patients, it also gained the registrar who had been assigned to radiology, she adds. Still, she says, wait times sometimes ranged as high as 30 minutes.
"Our administration is very sensitive to patient complaints," she notes, so the situation became a priority.
Because the hospital only has 80 beds, with 40 occupied beds constituting a big census, Lenz says, there are no registrars who remain on site in the ED. In the past, she adds, ED clinicians could call any one of three different numbers in central registration to alert one of the registrars that there was a patient who needed registering.
If the registrar who received that voice mail message was busy registering an outpatient, Lenz notes, there could be a significant delay. And because any one of three different registrars might handle ED calls, there were breaks in communication, she says.
"[The ED nurse] might say to one registrar, I told [another registrar] there was a patient in bed eight. Why hasn’t there been a registration?’"
Efficiency is the result
Under the new arrangement, in place since July 2002, Lenz says, one person is the dedicated ED registrar on any given day. That person wears a beeper at all times and, except during breaks, is the only registrar who responds to the one number that ED clinicians now call when there is a patient to be registered, she adds.
"They leave a message as to which [ED] bed the patient is in. Patients who have been triaged and whose condition is not urgent may be sitting in the lobby," Lenz notes, which also would be specified in the message. Otherwise, the ED registrar goes to the bedside with a clipboard, gets the appropriate forms signed, finishes the paperwork in a room adjoining the ED, collects the medical record, and has the patient wristbands made, she adds.
"The ED registrar has a worksite outside the ED where he or she keeps the files for the day," Lenz explains. "If an ED patient is admitted to the floor, the ED registrar completes the inpatient registration and hand-carries the file to the patient services representative, who is dedicated to [handling] inpatients."
The dedicated ED registrar is relieved from the responsibility of relieving the hospital’s PBX operator, which is one of the duties of the central registration staff, Lenz says.
The new system also facilitates the process after normal business hours, when each of the three registrars on duty might be tied up with various task, Lenz explains. "There might be one registrar on break, one on the nursing floor, and one registering a patient, which [in the past] means they frequently might not be able to answer the telephones quickly."
Again, she notes, the beeper system ensures instant communication. "After 5:30 p.m., we don’t have a dedicated ED registrar, but one registrar is wearing the pager at all times so the ED can continue to page when a patient needs to be registered," Lenz says. "There have been admissions after hours where the patient is sent directly to the intensive care unit (ICU) by the physician, and ICU needs the account put into the system so they can generate orders."
Although ED staff now love the new arrangement, they at first were resistant to paging a registrar rather than making a direct call, she adds.
"The ED manager and I decided we would push this through, so we had to create some incentives," Lenz says. "When the ED [employees] started calling our telephone numbers, we’d say, Sorry, you’ll have to page.’ They finally got frustrated and started to page."
Outpatient registrars, meanwhile, are delighted with the change, she says. "Everyone knows where they’re supposed to be. It’s clarified the positions and there aren’t any more of those fuzzy lines between jobs."
There also is a lot less waiting time, Lenz adds. "We probably see outpatients on the average in under five minutes."
Although the dedicated ED registrar system will remain in place, she notes, radiology registration will be decentralized again once some additions to the hospital are completed. "Patients don’t like having to walk two more halls to get to X-ray."
[Editor’s note: Monika Lenz can be reached at (760) 446-0629 or by e-mail at [email protected].]
When an infusion of radiology patients into the central registration process at Ridgecrest (CA) Regional Hospital led to longer waits and outpatient complaints, admitting/communication team leader Monika Lenz, CHAA, knew it was time for reorganization.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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