Collaboration with nursing getting more COAs signed
Admitters helped in education effort
Bryan LGH Medical Center in Lincoln, NE, has a new process for obtaining patient consent that has significantly reduced the number of cases in which the conditions of admission (COA) form is not signed, according to Marilyn Klem, admissions manager.
With the new procedure, there have been only about eight of some 350-400 charts audited each month by the hospital’s health information management department where consents were not obtained, Klem says. Most of the patients who didn’t sign consent forms were those transported by ambulance or who were in the progressive care unit or the intensive care unit, she adds. "It’s either because the patients are critical or because their family is not with them."
In the past, she explains, the patient accounts department sent a "dismissal card" to the nursing floor that would be put on the chart to indicate more information and/or a signed consent form were needed. "If the nurse saw the card, she was to call patient accounts and bring the patient down [to that department] so any missing information or consents could be obtained."
That process, which was very labor-intensive, became obsolete when the hospital moved to patient-centered care and began dismissing patients from the nursing units, Klem says. Later, when the hospital instituted a new preadmission procedure, the entire process changed again, she adds, because of the need to get account information in a more timely manner.
"The verifiers had been going up to the nursing floor and getting the consents at the same time they got other information [for direct admits], Klem notes. "They would spend hours on the nursing floor trying to catch up with the patients to get the information and consents. With the pre-admit process, the patients are contacted by admissions prior to their admission for patient demographic and insurance information. In other words, we try to get all the other information up front so the consent is all that nursing had to get."
With the nurses already doing patient discharges from the unit, admissions management worked with nurse educators to get their help with obtaining the consents, she says. "We put together training material about the COA. Nurses knew how to get consents for surgeries and procedures, of course, but not the general consent, which is a consent to admit and release information and a financial agreement."
Now, Klem adds, for patients who bypass admissions, her staff attach a notice to the front of the admissions paperwork that alerts nursing to collect the patient signature.
"The buy-off was, nurses would get the consent, since they were in the room starting the nursing assessment anyway," she says. "I think [the nurse already being in the room] was the selling point, plus the patient could leave the room and go right out the front door at dismissal."
[Editor’s note: Look for a discussion of other instances of how the hospital’s admissions department collaborates with nursing in the August issue of Hospital Access Management.]
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