Form improves accuracy, speeds admissions process
Buy-in from physicians’ staff was crucial
By Christine Winicke, Computer Specialist
Tammy Cieplowski, Director of Patient Financial Services
Beaufort (SC) Memorial Hospital
Normally, people groan at the thought of a new form. But at Beaufort (SC) Memorial Hospital (BMH), a new Physician’s Admitting Order Form has improved accuracy of patient information and increased the speed of the admissions process. (For a copy of the form, see p. 58.) This improvement resulted from the development of a 14-member interdisciplinary team that used the continuous quality improvement (CQI) method to enhance the hospital’s admissions operation.
Comprising the chief financial officer and representatives from admissions, utilization review, information services, medical records, nursing, a physician’s office staff, radiology, and laboratory, the team first studied the hospital’s existing process to ascertain its most significant problem. That turned out to be inaccurate or incomplete information on admission orders, provided to the hospital by physicians or their office staffs.
Preprinted forms
For example, it was common for the patient’s name to be left off the form, because there was no designated space for the name or the place where the patient was to go the intensive care unit or surgical unit. Admissions personnel would have to read the form, decipher the information, and try to make medical decisions.
As a second step, the team brainstormed nine critical elements required on a complete admissions order: patient name, admission type (inpatient or outpatient), where in the hospital the patient was to be admitted, precertification number, primary and secondary insurance umbers, date of birth, projected length of stay, diagnosis, and the physician’s signature. Data were collected for these elements to determine the frequency and extent of missing information.
The third step, data analysis, resulted in two significant findings: Hospital admissions order forms were not standardized, and forms with more preprinted information yielded more complete and accurate information. Two admissions order forms were in use. One contained blank lines and a space for the physician’s signature; the second included preprinted space for some of the nine critical items.
The data indicated that using the form with more preprinted elements increased the likelihood of obtaining information by 30% to 50%. The team hypothesized that if a redesigned form included all nine critical elements, then admissions information would be even more accurate and complete.
Five physicians and their office staffs tested that hypothesis by using the redesigned form. They were trained to use the form and received follow-up support when needed. Additionally, a fax machine was installed in the hospital’s admissions department so office staff could complete the form and send it over, allowing the admissions process to begin even before the patient arrived.
Ask for input
Results of the pilot study were dramatic. On the form with no preprinted information, the patient’s name was included only about 50% of the time. With the revised form, this figure jumped to 100%. Similarly, with the old form, the diagnosis was included only about 30% of the time; with the new form, that figure reached 97%.
The final step was to get physicians’ and their staffs to use the revised form. Part of the overall education process for the users was to ask for their input. Several physicians requested that the revised form be customized to meet their specific needs. For example, a doctor who always orders a surgical workup for his patients can include that in the medical section of the form. In other cases, a therapy consult or an orthopedic consult can be listed. The only condition is that the overall format has to stay the same; physicians can tamper only with the medical information in the middle.
Additionally, each team member was assigned to educate several office staffs regarding what information was required and why the form should be completed.
The team will continue to PDCA (plan, do, check, act) this improvement to meet the changing needs of the information required now and in the future. The most important lesson learned so far has been to take several departments which normally don’t work together but rely on each other’s information through the process together.
When the team first met, nursing didn’t understand the problems admissions was having. Nurses wondered, "How hard is it to get a patient name?" Admissions, on the other hand, didn’t understand why nursing would ask all kinds of questions when we called for a room. Our reaction was, "What does it matter? We just need a bed."
A lot of nurses initially wanted the order form to be completely different. They said, "Why do we have to include insurance information?" We had to work together to find a solution. It was a meeting of the minds.
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