The Patient's Journey Starts With Us!

In most cases, the registration staff are the first person to greet the patient.  They represent the organization and this first impression will establish the patient's perception of the hospital.  In addition to providing exceptional service, the staff must ensure they register the correct patient. 

The next important function performed by the registration staff is positive patient identification.  This is essential and failure to validate the patient's identity will create a risk to the patient and to the organization.  Historically, most discrepancies occur involving patient's who arrive by ambulance through the Emergency Department.  These acute patients bypass the registration area and are transferred directly into the Emergency Department treatment room.  Bedside registration is then required to ensure appropriate patient identification and to validate the patient's demographic information.  The discrepancies occur when the bedside registration task is not completed and the staff register the patient using the EMS or nursing home transfer information.  Unfortunately, these sources are not 100% accurate and as a result the incorrect patient is registered.

The impact of registering the incorrect patient is that the physicians/clinicians are reviewing the wrong medical history, allergies, diagnostic reports and medications for the patient they are treating.  Other then the obvious health risk to the patient, incorrect financial invoicing may occur and faxing of incorrect medical reports to the family physician are risks.  Prior to the electronic medical record (EMR), incorrect documentation could be manually separated and corrected but with the EMR many IT systems are impacted.  Also, electronic medical reports, as well as, data is transmitted instantly to a variety of external recipients (family physician, specialists, Ministry, etc.)  who all must be contacted to correct discrepancies.

To resolve this situation, staff must be educated on the impact of discrepancies and the importance of their role in the patient's journey.  Also, the Ontario government's initiative to replace the old red and white health card is necessary even if it is not a popular option with existing card holders.  Mandating photo ID health cards will improve positive identification and decrease fraud.

The next important function is obtaining and validating the patient's demographic/contact information.  Many patients perceive registration to be an obstacle for receiving care.  It is essential that the hospital can contact the patient and/or their relatives regarding their care.  It may be necessary to contact the patient regarding their abnormal test results or their follow-up clinic appointment.  Also, the relatives may be contacted as substitute decision-makers for care if the patient is unresponsive.

It is important that patient's are education regarding the importance of registration and that providing their photo ID, as well as, their demographic information may seem to be annoying but necessary for their care.

Census Day Update

The Federal Ministry of Statistics Canada has been contacted regarding the inconsistent practices throughout the province of collecting patient information from hospital related to Census Day 2011. Recommendations brought forward by the Chair of the PRNO will be presented to the Ministry.

NAHAM Annual Conference 2011 Update

The National Association of Healthcare Access Management Annual Conference was held in San Antonio this year. Several members attended representing seven healthcare organizations.

The learning labs focused on a variety of topics, including centralized registration, pre-registration to validate insurance eligibility and patient demographic information, employee performance relating to data quality and POS collections, and hospital self-services for patients (i.e. registration kiosks and internet portals). Also, there was a focus on improving the patient`s experience by expediting access to hospital services through the use of technology and centralization (central registration and appointment call centres).

There were two keynote speakers, Mike Rayburn and Kathy Dempsey. Excellent keynote speakers! Please visit their websites for more information.

The vendor exhibits included data quality and address validation systems. They also, demostrated a variety of registration kiosks. One kiosk included a biometric palm scanner for positive patient identification.

One of NAHAM`s three year goal is to expand into Canada. They would like to open an association chapter in Ontario. We have discussed the benefits for our members and their front-line staff. We discussed options of a Canadian version of their professional certification for managers and front-line staff. Further discussion is necessary with NAHAM and our PRNO members.

Update - Patient Access Associate Day

Our Patient Access Associate Day event was a great success. The front-line staff appreciated being acknowledged for their important role in healthcare.

Some members were unable to participate due to a variety of challenges. Since many organizations were still decentralized, the front-line staff reported to the patient care managers. Some organizations preferred to celebrate Administrative Assistant Day. Also, one organization could not use "Associate" to celebrate the event since this was an existing job title for another non-clerical group. The member suggested changing the event name to "Patient Access Personnel Day" similar to title used by NAHAM.

Our next event will be held on April 4th, 2012. I will be preparing an article for Hospital News to promote the event and communicate the importance of patient access in healthcare.

Patient Access Associate Day

Celebrate and recognize individuals who provide Patient Access Services on April 6th, 2011. Those individuals include Patient Registration Clerks, Appointment Booking Clerks and Bed Allocation Clerks. The patient's journey starts with them. For information on how to plan your event at your organization, please send your request to prnogroup@gmail.com .

How Do Clerical Staff Contribute To Patient Safety?

Our clerical staff:

• Clean their hands frequently


• Ask patients and visitors to clean their hands during their visit and when they leave the hospital


• Wear their photo ID badge to identify themself as an employee


• Use positive patient identification to ensure that we register the correct patient


• Obtain and verify the patient’s demographic information to be able to contact them for follow-up or their next of kin


• In the Emergency Department, obtain drug profiles for all eligible ER patients to prevent medication errors


• Hand out the patient safety & inpatient information brochures


• Report possible safety hazards


• Complete their annual health and safety courses (e.g. WHMIS, Hand Hygiene, etc.)

"What If?" - The Importance of Verifying Patient Information

Imagine a scenario where a person receives the wrong medication and it proves fatal. Or a person with an allergy and it goes unnoticed because the clinician is viewing the incorrect medical record. Or an elderly person, having to return to the hospital to sign an authorization form to release their reports to their family doctor because we did not verify the family doctor’s name at the time of registration.

Imagine the patient being labelled deceased when in fact they are really alive or vice versa? Imagine a daughter being notified that their mother had past away unexpectedly, when in fact they were alive. Now, imagine this happening to your family member/friend?

How about your personal medical chart? Do you value its integrity? Do you want it to be accurate and up-to-date? Would you appreciate someone charting the wrong information on your chart or the possibility that these errors could influence your medical care in the future? You receive a call that your personal information was released resulting in the breach of your privacy, would you trust the hospital and their staff?

Now, imagine this happening to you.

These scenarios are possible when clerical staff fail to register the correct patient.

What if you worked in Health Records or you were a Lab Technician or a Business Office Clerk? Would you like these errors to affect your job every day? Would it bother you, if you had to perform extra work as a result? Would you feel frustrated with the errors? Would you be confident with the quality of work produced by that department?

Positive patient verification is an important part of the registration process.

Clerical staff are accountable for ensuring that the right patient is scheduled, registered or admitted. They are the expert. The hospital depends on our accuracy to ensure that the correct patient is being treated. Patient verification happens in three stages: Searching, interviewing and confirming.

TIPS FOR VERIFYING PATIENT INFORMATION:

1. SEARCHING:

• Always begin a search by health card number. These numbers are unique for every person in Ontario regardless of their name and date of birth.


• If the patient has no health card number search by date of birth. Be careful that you select the right patient. Double-check the correct patient name.


• Search by name as the last resort as this is the least accurate. Why? Names can be very similar or spelled incorrectly and many names are common to more than one person.


• Request for government issued photo identification if you are in doubt.

2. INTERVIEWING

• Use WHAT, WHO? Always probe the patient to provide information when interviewing them. For example: What is your current address Mr/Mrs…? What if your current telephone number? Who is your next of kin?
  DO NOT ASK: “Is everything the same?” or “Is your address the same?”. Patients may agree without knowing what we have in the system. Maybe they haven’t been here in years or moved at some point and forgot to mention it.
  DO NOT REPEAT PATIENT INFORMATION: “Is your address 123 Anywhere Street?” or “Is your phone number xxx-xxxx?”. The patient may respond “Yeah, yeah” to everything automatically because they are annoyed or disoriented.


• Use their name frequently in conversation. If it’s not them they will notice.


• Scan the demographic sections quickly. Does it make sense? Is this patient a male/female? Are they an adult or child? Do they look like they were born in 2002?


• Validate their emergency contact and next of kin information every time. These contacts play an important role in verifying the patient in the event that they are unconscious at the time of arrival or if they are pronounced deceased.

3. CONFIRMING

• If we are placing an I.D. bracelet on the patient, take the time to show them their information on the bracelet and ask if their information was entered correctly.


• If you are expected to obtain a RAS signature for accommodation, this is an excellent way of confirming the identity of the patient first hand. Ask them to verify the information on the form and sign or ask their family member to do so. By doing this, we double-check our registration information as being correct.


• If the patient is brought in unconscious we should be contacting the person listed as their emergency contact to confirm their identity. Do not feel uncomfortable about this. This is why we collect this information to use it when they are brought in for an emergency situation, especially when unconscious.


• DOUBLE-CHECK AND TRIPLE-CHECK!!! Use common sense and do not assume that any information is correct until you verify it.
  
  Mistakes may occur and will happen at some point or another. We can try to prevent them by following the correct protocols and exercising the proper process to correct them when they do occur.