Ask the Expert: Getting Staff to Embrace Bedside Registration

Q: Registration leadership wants to know what’s the benefit to their staff to use WOWs. What is your opinion? Do you know of any resources that would assist us in coming to a common ground? 

Background: I am an RN consultant working with a community hospital emergency department (ED). A few of our major focus areas are triage, immediate bedding, and bedside registration. We are working with an ED registration leadership group who do not “buy into” what the clinical team sees as the best practices in bedside registration. The registration team is promoting a traditional approach of taking a form on a clipboard to the bedside and writing down the patient information and then walking to their office to enter the data into the ADT system. The organization has invested in workstations on wheels (WOWs), but there is a good deal of push back from registration. They feel they are too cumbersome and that the staff have to walk back to the office anyhow to scan and print.

Two experts answered this question. 

A: With the advent of mobile and wireless technologies, so-called “bedside registration” has become widely accepted as a revenue cycle best practice. There are three primary reasons to embrace bedside registration:

Higher customer satisfaction. Due to the nature of ED services, patients are often transported directly to clinical-care areas. Often, these patients may not be accompanied by family members or other persons who can give accurate social, demographic, and insurance information for/on behalf of the patient. Thus, registrars need to interview patients at the point of care. Previous to the development of mobile technology, this had to be done with pencil and paper. Information then had to be transcribed into the system before an online clinical record could be created or accessed, and/or form sets could be printed. This process is, obviously, slower than online bedside registration. When the data entry is performed at the patient’s bedside, patients (who are already eager to begin their care) are registered faster. In turn, they have a better customer service experience. ED physicians and nurses also have a better perception of ED registration when online bedside registration is the norm. Finally, many EDs today compete on the basis of wait times. Online bedside registration supports the goal of reducing total patient wait times in the ED.

Higher data quality/lower denials. When patients are interviewed at the bedside and the data are keyed directly into the registration system, the potential for transcription errors is reduced. Further, the process of doing a final data check with the patient is accelerated. Both of these benefits lead to an even-greater benefit: potentially lower denials. When data quality is improved, technical denials (i.e., returned mail, insurance not valid for the date of service, etc.) are consequently lower. If the hospital currently tracks denials by reason and service location, it would be an easy process to compare these key performance indicators (KPIs) before and after implementation of online bedside registration.

Improved point-of-service collections. When registrars have already been to the patient’s clinical-care setting, it becomes easier to return to ask for deposits/copayment amounts after triage is complete, and/or to return to collect the total estimated self-pay amount after care is concluded. When these “cashiering” activities are conducted in patients’ ED treatment rooms rather than in another location as patients are eagerly trying to leave the ED, point-of-service collections are typically more effective. Again, if the hospital already collects ED point-of-service collections KPIs, it will be easy to conduct “before and after” comparisons.

If you would like some additional material, I simply Googled “ED bedside registration,” and many good articles come up on the first search-results page.

On the hardware front, there are now carts available that incorporate formset and armband printers. This eliminates the problem of having to walk back and forth from patient treatment rooms to registration to retrieve these items.

David Hammer, vice president, McKesson’s Business Performance Solutions Group, answered this question.

A: There are a few sources available to help with transitioning WOWs into the ED process. According to a recent blog post, York (ME) Hospital finds bedside registration in the ED one of the most effective tools to ensure an accurate and compliant patient claim.

Pat Finnemore, CHAA, who works on the patient access team at the 11-bed ED facility, said, “We have not found this process to be more difficult at all. We have an excellent working relationship with the clinical staff. Patients also like not being shuffled around. They can get in and get comfortable.”

In addition, the Robert Wood Johnson Foundation published its findings on bedside registration and how it is a proven solution to ED crowding. Download the entire RWJF report. 

Todd Nelson, technical director, HFMA, answered this question.

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