Customer service prompts one-stop registration
’Once Is Enough’ team formed
When Beaufort (SC) Memorial Hospital took a long hard look at the issue of customer service, it led to one-stop registration for outpatients, a pilot program for wireless registration in the emergency department using a laptop computer, and a planned move to centralized scheduling. And it’s not finished yet, says Tammy Cieplowski, director of patient financial services, who describes the focus as bringing the service to the customer, rather than vice versa.
In 1995, the hospital formed a continuous quality improvement team called "Once Is Enough," based on the premise that the patient should have to check in only once. The team included the hospital’s patient liaison and representatives from admitting, information services, X-ray, laboratory, and respiratory therapy. Team members decided to focus on outpatients and leave inpatients for a later effort because they realized the two processes were very different, Cieplowski says.
To meet the ’one-registration’ goal, the hospital launched a renovation of the main registration area designed to make it more patient-friendly. One key issue was patient confidentiality. "The old booths were very short, and you could hear everything that was said," Cieplowski explains. "We had to make it more private, so we redesigned the booths, putting two booths for billing personnel behind a glass partition."
For the patients’ convenience, the billing booths were placed near the registration booths, while the rest of the billing office remained on the fifth floor. A receiving area was added, with an information person to take charge of the waiting room. Where formerly there were three doors leading from the registration area to the rest of the hospital, after the renovation there was one main door, eliminating the confusion that sometimes occurred as patients were sent to various departments.
The redesign also involved a new patient-focused protocol, Cieplowski says. Now when a patient needs to speak with a billing representative, the registrar picks up the phone and has the billing rep come to the patient, rather than the reverse.
The "Once Is Enough" team, which disbanded during the construction period, resumed its work in May, with the aim of continuing to have the employees not the patient do the "legwork," she adds. The focus was on patients coming in for cardiopulmonary, laboratory, or imaging services.
Although the result patients check in at the registration desk and are escorted to the appropriate treatment area works very well, there were some bugs to work out, Cieplowski says. "The first day was a disaster," she admits. Registrars were tying up the phones calling the ancillary departments to let them know their patients had arrived. Technicians were arriving to pick up the patients, but because they hadn’t been informed exactly what preparation was required for that patient, there was a wait before treatment.
"If the patient is coming for an MRI and needs sedation, the techs need to know so they can start the sedation process," Cieplowski explains. "They would come out and get the patients, but the [imaging department] wasn’t ready for them. We realized we needed to figure out a better communication between registration and the three [ancillary] departments."
The solution was to move an employee from the imaging department to the front information booth and cross-train her so she also could perform admitting functions. She now registers the patient and immediately places an order specifying what is needed for that particular patient. The order prints out in the imaging department or laboratory, where a technician picks it up along with the patient, eliminating the extra phone calls.
There also are plans to move to centralized scheduling the hospital has purchased software from Meditech in Boston after system upgrades are complete, Cieplowski says. Under that plan, one person will do both preregistration and scheduling. The hospital also plans to cross-train employees in admissions, imaging, and eventually the other ancillary departments.
Barbara Laing, RT(R), director of imaging services, says the most exciting part of the new process is that none of the departments involved have been territorial in approach, focusing instead on the patient’s best interest. "It’s working beautifully," she says. "The patient doesn’t have to leave one waiting room to go to another."
The ultimate goal, Laing says, is to have patients come directly to the point of service and experience minimal inconvenience during registration. Until the facility’s space restrictions are removed, however, the current plan appears to be the best solution, she adds. "We also want to find out the patient’s perception. We think we’ve improved things, but does it make any difference to them?" A survey is being sent to frequent patients to see if they’ve noticed the changes.
Meanwhile, a committee including the emergency department (ED) director, Cieplowski, other registration staff, and a nursing representative is focusing on ED concerns. "We had looked at wireless registration for inpatients, and we wanted to do a pilot in the ED, a controlled setting, to see what limitations it would have," she says. "The registration desk is far from the patient rooms, and when a patient comes in through the ambulance bay, [registrars] had to write everything in the treatment room, take it back to the registration computer, generate a chart, and then take that to the patient in the treatment room."
In the middle of a 30-day demonstration of wireless technology, the department is seeing dramatic results, Cieplowski says. Registrars take a laptop on a cart to a patient’s room, generate a chart, and do the entire registration there. The process immediately eliminated the five minutes of "walk time" involved in an average registration.
"The reaction from my staff has been phenomenal," she says. "There’s more time for customer service. When the registration is complete, the laptop is available to ED nurses, who use it to pull up the electronic medical records, order labs and X-rays, or get results from previous tests." Otherwise, nurses would have to complete these tasks at their workstations. "For our needs, one laptop is enough. We register on average 1,800 patients a month, about 60 a day, in the ED, and I have one registration person on [duty] 24 hours a day." When the registrar leaves the room, the switchboard operator fills in so someone is always available in the ED lobby.
In another effort to bring service to customers, Beaufort Memorial has installed an embosser and a printer in the labor and delivery area, which is a considerable distance from the registration department. "Patients’ families were having to leave their loved one to come and register," Cieplowski says. "Now we let the patients call and register over the phone from their rooms. We print everything back to the nurses’ station, the nurses get the appropriate consents signed, and then admitting personnel go back to labor and delivery every morning to make sure we don’t need any insurance cards, and that everything is signed and ready to go."
A similar process is used for newborns, with nurses doing registration over the phone, and the chart generated to labor and delivery. That system, in place since late August, has been well received, Cieplowski says. "It helps expedite nursing, and the families don’t have to leave the patient."
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content