Sounds like you have the system we had prior to implementing registration by a "meeter - greeter" which entails either selecting a patient from previous registrations and initiating a new encounter ( less than 1 minute) or adding a new patient ( similar to what has been mentioned - "quick registration - just name / DOB/ complaint to get a record intitated ( 2 minutes).
In that system, although there is constantly angst raised by some that the patient is now seeing a nonclinical person initially, at least they are seeing someone. In the past, the quiet but very sick patient who arrived behind a bus load of other patients waited for a significant period of time with no chance at all of being assessed by the triage nurse. At least in this system, a meeter - greeter (who in my estimation simply needs to have the same judgment as my mother), is able to see that someone bleeding on the floor or complaining of chest pain or who just "looks sick" needs to be directed to the triage nurse ahead of other patients. Regulatory agencies of course require more than that, and so we have developed limited training and made it a part of the competency of those who serve in this role.
There are a couple of other issues you should be aware of immediately if you go to this process. Unless you have significant amounts of registration staff, it is sometimes difficult to have a registrar initiate the record for EMS arrivals. For that reason, only at EMS triage we'll allow nurse's to do the quick registration. We will find that clinical staff are not as compulsive as registration staff, and this will create a certain amount of errors that will need to be corrected when the full registration is done. We have not found it to be significant enough to abandon the practice, but it does require some trust on the part of your registration staff who will generally be opposed to allowing any registration to be performed by clinical staff.
I think another significant advantage of doing it this way is that you will actually began to get a sense of real arrival time, we have done some six sigma work and based on actual observation our arrival time in the system now reflects the time that is 5 minutes or less from the actual moment the patient walks through the door. I believe that there are also operations where there are a number of patients who are abandoning a request for care between the time they arrived and the time they finally get to the triage nurse. You will be able to track those patients as well by doing this.
Michael Werdmann, MD
Chair, Dept. of Emergency Medicine
267 Grant St.
Bridgeport, CT 06610
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On Feb 18, 2012, at 1:58 PM, Nancy Piotrowski <[log in to unmask]> wrote:
> Our institution will be converting to an electronic health record this
> fall. I have some concerns regarding the triage process. The
> registration process must be completed prior to the RN having access
> to the patient document. If multiple patients are registered but not
> yet triaged how do you ensure critical patients are not sent to the
> waiting room until their turn to be assessed by the nurse?
> I've been told
> by a couple of other institutions that they've resorted to giving the
> registration personnel a list of chief complaints that they are to
> alert the nurse to. This seems like an absurd work around for getting
> the right patient to the right place at the right time. Not to
> mention a huge liability for the hospital.
> Any comments or suggestions?
> Nancy Piotrowski
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