Registration By RNs in Triage or ER Registration Clerk?

[Rickbos]

We are trialing a new triage system to hopefully improve flow that has the triage RN do a portion of the patient registration, apply the ID bracelet, do the triage assessment, and then place them in a room after triage(if available) and the registration process is completed by clerical staff.

Do any of your triage procedures involve the triage RN doing patient registration, or is that done solely by the ER registration clerks? The triage RN feels it slows down their clinical assessment and it would work more efficiently if the ER registration clerk did a "mini" registration for arm band, stickers, and a face sheet with demograpics, simultaneously while the RN was triaging the patient.

What do you do out there?

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Because of federal laws (COBRA), for hospitals accepting federal funds, it can never appear that the patients' financial status has any bearing on their evaluation by a health care provider. This creates a bottleneck at evaluating the patient and having something to document on. That's why they shouldn't be registered before seeing a nurse or doctor, yet the the nurse or doctor need some type of registration for documentation needs. It's a classic Catch 22 deal, and I've never seen a good solution that works for both clinical and registration needs. I know this doesn't answer your question, but I hope the background information helps you see what you're up against. Before COBRA, people were regularly transferred or given low priorities for financial reasons. I took many transfers in my EMS days from private to county hospitals and even had patients die en-route because they couldn't pay the cost at the private hospitals' ER. COBRA is a big improvement, I'd hoped Obama would carry the ball further.

[AndyLyn]

Our patients are met by a registration clerk who does a "quick reg", gives the stickered chart to the triage nurse who does a "quick assessment", and places the patient in a room, if possible. Then the patient is "full reg'd", the chart is up for the doctor or nurse (whoever gets to it first), for either the doctor to see, or the nurse to complete the H&P and do the med rec. It's a new system for us, about a month old, but seems to be working OK. There was a lot of complaining at first, because the bedside nurses were used to having the H&P and the med rec done by the triage nurse, but we're getting over that.

[Rickbos]

We were proposing the patient upon arrival(if well enough to do so) fill out a carbon less copy triage form that has basic demographics(name, DOB, complaint, & med list). One part of the carbon less copy goes to registration and the other goes with the patient to triage . The registration staff would create a face sheet, patient labels, and an ID bracelet, while the patient is being triaged. The rest of the registration is completed in the patient's room. If the patient is not well enough to be seen in the triage room, everything s done in the room.

[Dazglue, ADN, BSN, MSN, RN]

I work in ER reg. At our facility we have a greeter at the front door (usually a tech in case a patient comes in with chest pains and they can get an EKG within the 10 minute requirement). The greeter gets the patient's name, DOB, SSN (if they know it) and complaint on a carbonated slip. The slip is passed to registration and the patient is "quick-regged". An armband, labels, and ER face sheet will print out and the triage nurse area. The patient is called into triage and afterwards will be taken to a room (if available) and then the patient is updated. However if no rooms are available the patient is triaged and then brought over to a registration window to be updated. The MUST be triaged before ANY insurance information is asked about by law. If a patient comes in by ambulance it is the same process except the patient goes to straight to a room (unless it's non-emergnt) registration go asks for the patient's name, DOB, SSN, and complaint and then the patient is "quick-regged". After the patient is triaged then the patient will be updated. But as far as the RN, he/she must verify the patient's name and DOB before putting on the armband. It works great for us.

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Good systems one and all. The mandates introduce inefficiency, but certain private hospitals brought it on all of us by putting profits before people.

[TiggerBelly]

Patient comes in the front door and fills out a form with their CC, Name, DOB, SSN and phone number. The triage clerk then does a "pre-reg" which prints out a sheet of stickers and an armband. At no time during the pre-registration do we ever know if the patient has health insurance (unless the patient presents the card to us without us asking, assuming we need it at that time). The patient then goes in to see the triage nurse. If rooms are available, then the patient is moved into a room where the registration person comes to them and gets the insurance card, proof of identity, signs the HIPPA stuff etc. If no rooms are available, then patient sent to registration office where all of the above are done. HHTH

[canoehead, BSN, RN]

Triage nurse sees the patient first and pulls them up by name and date of birth. After triage they are sent to registration, or registration goes to them, to confirm or fix the rest of the information. If the patient isn't in the system we can create a new account using just the name and DOB.

[JBudd, MSN]

The biggest sacred cow in our triage is that an RN has to be the first to talk to a pt. So, one nurse sits at the window, has the pt fill out a slip with name, dob and complaint, puts the stuff into the computer for a quick reg, prints the labels and band, and then either goes on to triage (assess) the pt or pass them to another nurse for triage. We do bypass some of it for chest pain or severe distress, and the quick reg stuff follows them down the hall on the way to a bed.

[DC Collins, ASN]

Patient comes in the front door and fills out a form with their CC, Name, DOB, SSN and phone number. The triage clerk then does a "pre-reg" which prints out a sheet of stickers and an armband. At no time during the pre-registration do we ever know if the patient has health insurance (unless the patient presents the card to us without us asking, assuming we need it at that time). The patient then goes in to see the triage nurse. If rooms are available, then the patient is moved into a room where the registration person comes to them and gets the insurance card, proof of identity, signs the HIPPA stuff etc. If no rooms are available, then patient sent to registration office where all of the above are done. HHTH

This is the method our facility uses. Protects us / the pt from the chance of $ affecting care, but basic, necessary info for triage / room placement is gathered immediately.

DC :)

[Golfenaround]

Walk into our ER waiting room, take a number.

The triage RN calls the number...assess the pt....assigns a CTAS code...if they are 3, 4, 5, they are sent to the waiting room. The triage nurse puts the EPOD chart (electronic triage) into the appropriate slot. Everytime a patient presents to the ER, we EPOD / triage them and it is a blank sheet. The registration/admission clerk registers them.

CTAS 1, usually VSA come in by EMS

CTAS 2, depends could be chest pain, diabetic ER or HTN ER, CVA, pain...etc....some you just bring in and start the work up....they are usually keepers.

[Rickbos]

Do you, as an RN, have to enter the patient name, DOB, ER doctor, and print out an ID bracelet & stickers as part of triage as part of your electronic triage?