Immediately report these clinical concerns
Registrars are part of team
Your registrars might not have a medical background, but that doesn't mean they can't potentially save a patient's life.
Patients have fainted, developed chest pain, and had seizures in registration areas at University of Utah Health Care in Salt Lake City, reports Karen Duncan, nurse manager in the admitting department. In each case, registrars immediately called the hospital's Rapid Response Team.
"Registrars should always believe that they are part of the patient's team, because the patient sees the registrar that way," says Duncan. "The patient has shared the reason for the visit or diagnosis with the registrar, which is very personal information."
Registrars have shared concerns about suspected abuse and patient statements concerning suicide with clinical staff, adds Duncan. "The registrar and manager decide how to share that information with the provider caring for the patient," she says. "The specific words and context are very important for the provider to understand."
During the day shift, registrars report concerns to their admitting supervisor or manager, and off hour and weekends, the registrars page the nursing house supervisor.
"We have had a patient and tell a registrar that he was feeling suicidal. The registrar excused himself from the desk and walked the patient to the Emergency Department," says Duncan. "We have also had a patient tell a registrar that her portable oxygen was empty. The registrar called our Respiratory Therapy department to bring portable oxygen."
Positive outcomes
It is crucial that registrars pay close attention to comments made by the patient and parents, says Pamela Konowall, manager of health care access at Cooper University Healthcare in Camden, NJ. "The clinical staff has complimented the registration staff on numerous occasions because they have communicated their concerns regarding patient's conditions," says Konowall. "In doing so, potential critical situations have been avoided."
Cooper University's registrars have alerted clinicians to a lethargic infant, a child who was having difficulty breathing. "Both were Level one emergency situations, both were admitted, and both had good outcomes due to the quick thinking of the registrar and the fast action of nursing," says Konowall. "Clinicians immediately assessed the children. Care was rendered without delay, which had a positive impact on the outcome."
Registrars have also alerted clinicians to adults with chest pain, adults with difficulty breathing, gunshot wounds that presented through the main entrance of the ED rather than an ambulance entrance, patients who say they have been sexually abused, patients who are extremely anxious, and patients who have threatened to hurt themselves or others. To elaborate on the examples of the two children referenced; Cooper University Hospital ED clinical staff is easily accessible to the registration staff. The preferred and quickest method of communication is to verbally alert the clinicians immediately of any concerns a registrar might have.
"If a patient's condition or symptoms worsen while they are in the waiting area, registrars alert clinical staff," says Konowall. "The bottom line is, if the registrar has any concerns, the clinical staff prefer that they be notified."
Sources
For more information on registrars reporting clinical concerns, contact:
Karen Duncan, Nurse Manager, Admitting, University of Utah Health Care, Salt Lake City. Email: [email protected].
Pamela Konowall, Manager, Health Care Access, Cooper University Healthcare, Camden, NJ. Phone: (856) 342-2437. Email: [email protected].
Ronald G. Marcum, MD, Director, Integrity Office. Oregon Health & Science University Hospital, Portland. Phone: (503) 494-8849. Email: [email protected].
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