Rethinking Registration: Changing the Check-in Process for Emergency Departments

June 4, 2014  |  Delia Caldwell

As EDs look for ways to improve efficiency, one possibility is to consider is the registration process. It’s an essential step in getting the patient into the workflow of the ED, yet in practice it can often become a bottleneck. There are a variety of approaches that EDs are following to rethink registration — ranging from process improvements to the use of technology.

Configuring the Team

One of the most fundamental strategies that can improve the registration process is to ensure that the registrars are considered and treated as part of the care team. This might seem like an obvious point of view, but it is not always the case. For example, when the registration staff are dispatched from a central area, they may not be aware of how to determine which patient to register first.

In team staffing configurations, however, primary nurses and technicians can help the registration staff be more focused and efficient by identifying which patients should be registered first. For example, some EDs are using color coding to prioritize patients based on their acuity level. Periodic team huddles can facilitate the exchange of communication to keep the registration process flowing.

Some EDs have taken this concept a step further, implementing systems in which patients are assigned a triage level first, followed by immediate bedding and bedside registration, with registration fully completed only after the physician’s evaluation is done. One piece of equipment that has proven useful in effective bedside registration is the workstation on wheels (or WOW). This equipment can be moved easily into the space where the patient is waiting to be seen, whether they’re in a vertical chair or on a stretcher. The registrar can sit with the patient in a private space and gather information, using the WOW to scan patient IDs and insurance cards, and process copays made by credit card.

Identifying the Right Resources

Other approaches involve the use of select technologies to aid in the registration process. These approaches range from initiating “fast pass” processes and allowing patients to preregister well before they visit the ED in an emergency, to patient tracking systems that require manual input or that passively monitor patients by wireless technology, such as through the use of patient bracelet locators.

At FreemanWhite, we conduct process documentation — and detailed analysis of the findings that result — to help clients identify the specific parts of their registration processes that may be problematic, and design customized solutions that employ one or more of these strategies or others, based on their needs.

 ABOUT THE AUTHOR     Delia Caldwell MBAoutcome_swarming_Delia Caldwell
Delia Caldwell works with clinical staff to put the systems and processes in place they need to improve care and save lives. Through simulation modeling, process mapping, and dashboard tools she helps departments reduce LOS, improve patient outcomes, and streamline operations. A skilled facilitator, Delia guides organizations through change, using data to demonstrate that her recommendations will improve productivity and efficiency. With more than 85 operational studies completed, her efforts have redefined the way that providers deliver care. Read more from Delia.

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