Basic registration Procedures

1. Basic registration Procedures Part one

2. Admitting/patient registration • nearly everyone who enters the hospital has contact with patient registration • Some are admitted while some are day patients • Some facilities are small and staff do all the jobs while others have different staff assigned to one job

3. Some responsibilities include • Pre-admissions registration • Pre-admission testing • Operation room scheduling • Financial interviewing • Birth and death registration • Consent forms • Bed assignment • Patient escorting • Liaison with doctor’s office • generating statistics for other departments • Registering for outpatient and ER • Census and other forms • ID bands and cards

4. skills • Computer and KB speeds- you need to be comfortable with Windows and DOS- requires you to be able to follow directions • You need to be fast and accurate • Average speed per admission- 5/8 minutes • Medical terminology to assign beds to the correct service • Problem solving • Critical thinking • Ability to see the big picture – • Integrity and politeness • THE LAW!!!!!

5. The ability to learn new things • Computers change • Policies and procedures change • Everything changes • AND so must you change • You musts be willing to learn the new procedures • You will adapt

6. The big picture • What is going on throughout the facility • Know who is “off service” • Off service means who is on a unit where they don’t belong; in the class we learn “best practice” but the reality is patients are put in a bed and the appropriateness of the bed is sorted out later

7. A thick skin • You are always on the look out for beds • You make extra work for nurses and unit clerks • You may ask nursing staff to admit a patient at 0300- I’ve had to do it and believe me I have grumbled about the patient registration staff • You may have move patients due to doctor’s orders or for insurance purposes • You will not be popular!!!

8. But remember ….. • This is a chance for you to help patients and families during trying times but being kind and processing their information quickly and efficiently

9. Statistical uses in patient registration • In order to comply with government regulations, insurance policy changes facilities rely on the patient registration department for generation reports

10. Data elements analyzed on a daily basis include • Amount of admissions • Discharges • Transfers • Add-ons( emergency and non emergency ) • Cancellations • No shows • Starting and ending census • Future reservations • Physician availability • Daily usable beds • And many more

11. This data • Is shared with administration central supply and all other departments that are affected by admissions • Admissions can be broken down into planned and added on • Can play a vital role in staffing

12. Definitions • Inpatient census- the number of inpatients present at any given time (CTT) • Daily inpatient census- the number of inpatients present at the census taking time plus any patients who were admitted and discharged during the day A&D • Total inpatient service days- the sum of all inpatient service days for the period under consideration

13. Definitions • Average daily inpatient census- the total inpatient service days for a period divided the total numbers in the in that period • Length of stay- the number of calendar days from admission to discharge ( not including the day of discharge) • Total length of stay- the sum of the days of any group of inpatients discharged during a specific period of time

14. Definitions • Average length of stay- the average length of hospitalization of inpatients discharged during a specific period of time • Inpatient bed count- the number of available inpatient beds ( occupied /unoccupied) on any given day • Inpatient bed count days- the sum of inpatient bed count days for each of the days in a period under consideration • Inpatient bed occupancy ratio- the ratio of inpatient service days to bed count days in a certain period

15. Reports generated by the patient registration department • Admission schedule by date sequence- a listing of reservations in alphabetical order by date • Admission schedule by patient name- an alphabetical list of reservations • Future reservations by service and date- service such as surgery, medicine, • Future reservations by physician- in date order

16. Reports continued • Schedule changes – a list of reservations that was changed from one date to another • Daily admissions- list of previous day’s admissions • Nursing care worksheets- a list produced daily for each nursing unit to complete patients current status at the start of each day • Daily transfer sheets

17. Reports • Daily service charge- inpatients currently being charged • Alpha list- an alphabetical list of all patients • Census summary by unit- daily, weekly, monthly, yearly • Census summary by physician • Census summary by service • Daily dismissal sheets-all patients discharged in previous four days

18. Reports • Admission/data card- • Unit activity sheets- admissions transfers and discharges • Financial audit report- financial data entered in system for audit purposes • Off service- a list of patients not on the correct unit-service • Summary of discharges by service- • AND MANY MORE !!

19. These statistics .. • Help our government plan health care – • Watch trends in health care • Track diseases • Redistribute care • Avoid duplication

20. Roles & responsibilities • Reservations- from doctors • Active, associate courtesy and honorary staff • Courtesy doctors receive permission to treat a specific patient • Honorary staff- retired • Process birth and deaths for the Department of Vital Statistics • Assign beds • Slate surgery • Process day surgery , tests registration

21. Admission categories • Emergent- threat to life or limb • Urgent- may be harmful if a long delay • Elective – planned • However some facilities use their own categories

22. Information for reservations include • Admission date • Doctor • Doctor’s code/number • Service • Accommodation requested • Type of admission • Patient demographics • Diagnosis • Your initials

23. Preadmissions • Once reservation or request is made patient is either called or receives a admission booklet in the mail – time permitting • Copy of hospital forms • Information brochure • Patient instructions • Financial policy • Tests and documentation required

24. Preadmission tests • History & physical from doctor including pre-op diagnosis and proposed procedure • Lab work- hemoglobin, hematocrit , chest x-rays, EKGs as required • People over 40 usually get the chest x-rays and EKGs and perhaps cardiac enzymes and people with other health issues can other tests • All tests and documents are time sensitive

25. Bed assignment • Beds are assigned by service • Some units have set criteria- for example ICU, NICU, psychiatric units • Other considerations are- gender, age, diagnosis, infection control • The larger the facility the more options there are • Today though a patient might find themselves in a room with the opposite gender • Funding may require all beds to be filled

26. Bed assignments • Some hospitals are fully computerized but others despite computers use a bed board to get a visual of the hospital and its beds • Victoria hospital likes the bed board • Colored coded to easily see open beds , pending admissions occupied beds

27. Admissions • Via ambulance and emergency • Planned- elective and through preadmission process • Hospital to hospital

28. Transfers • Bed to bed within a unit • Unit to unit • Hospital to hospital – discharge transfer

29. Reasons for transfers include • Insurance coverage- private room can be from patient or family • Doctor- suspected infectious disease • Nurses- bring a confused patient closer to desk • Admitting – correct an off service patient • Epidemiology- stop an infectious disease

30. Discharges • Get better and go home • Discharge transfer to another facility of long term care • Expire • Except for the last one- a doctor’s order is needed • DRG- diagnosis related group helps plan for discharges through use of statistical data related to the diagnosis

31. Infection control • With the rise of antibiotic resistant organisms admitting staff now ask if a patient has ever ben in a hospital with the last six months- helps track infections • Admitting is at the centre of pandemics, disaster bed utilization, • Refer to the infection control chart for sample patient placement

32. Payment codes • 1-MHSC • 2-government of Canada • Manitoba WCB • Self-pay • Other • Other provincial health care plan

33. examples • 1- MHSC- most residents including a prisoner • 2-Armed Forces, war vetran, RCMP, prisoner in federal penitentiary • 3-Manitoba WCB-if the reason for current hospital services are as a result of injury from employment • 4-out of country, personally responsible for charges, student in Canada but permanent of another country • 5- WCB of another province • 6- someone from Ontario

34. Ambulatory surgery, NFA • Today many procedures are day surgery only • Still require testing, registration, inclusion in certain statistics, a bed for the day, a meal perhaps, time of a doctor or nurse • Surgeries must meet criteria as to length, need type of surgery etc

35. Bed board