Chapter 7: Scheduling and Registration Processes
The Basics of the Admission Process
Hospital clinical software systems typically have many different registration modules, for example, inpatient registration, outpatient registration, ED registration, and day surgery registration. However, the registration process across all these types of registrations is similar.
Performing a Patient Search
Upon a patient’s initial pre-registration or registration at a hospital, they will be assigned a unique identifier in the hospital’s clinical system; depending upon the organization, this may be termed a MRN, HO#, or patient/hospital alias. Once their pre-registration or registration is complete, they will also be recorded in the clinical system’s master patient index (MPI).
During any subsequent pre-registration or registration process, the registration clerk must carefully search their system’s MPI to ensure that they are linking the registration they are completing to the patient’s existing health record at that facility if one exists.
First, the registration clerk must perform a search for the patient they wish to register. The most common search method is by Ontario Health Card number – most hospital registration kiosks are equipped with Health Card swipe readers for this purpose. If the patient already exists in the hospital clinical software system, swiping the Health Card will pull up their patient record with their unique identifier (MRN/HO#/patient alias). From there, the registration clerk can choose the existing pre-registration for that date or start a new full registration, which will connect with the patient’s existing record.
If the patient does not exist in the system, swiping the Health Card will bring up simple demographic information on file from the Ministry of Health. The registration clerk will then complete the pre-registration or registration process, which will result in the patient being assigned a unique identifier (MRN/HO/patient alias) upon completion. In addition to the MRN, each patient encounter will be assigned a specific code or number in order to differentiate it within the MPI and for billing purposes. This number may be termed an account number, fin NBR, or visit number.
Take Note! — Not Everyone Has a Health Card
Some patients may not have an Ontario Health Card, such as newcomers to Canada, international or out-of-province students, and members of the Mennonite community. In this case, search methods may include first name, last name, D.O.B., and even address.
It is important to use caution in registering without a Health Card, as many names may be the same or similar.
Completing the Registration
The registration conversation or script differs between types of registrations, with the registration clerk being guided by prompts to complete certain fields. In addition to asking for financial and demographic information, the registration clerk may also be required to conduct simple screening or clinical tests during the registration process, such as:
- screening for COVID-19,
- completing a short falls risk assessment, and
- screening for nosocomial infections such as MRSA and VRE.
At the conclusion of the registration process, the registration clerk will file/complete/save the registration, which will be added to the MPI under the patient’s unique identifier. Depending upon what level of electronic records the hospital has implemented, the registration clerk may then be required to print out documents such as:
- face sheet,
- treatment records
- patient labels to identify paper records,
- consent forms,
- patient armbands: typically white, red, green, plus a possible orange band.
Depending upon the procedure they are having and the type of unit, the clerical staff may also be required to
- apply the patient’s armband,
- obtain and witness patient consent on treatment forms,
- instruct the patient on specimens to be collected, and
- take the patient to the room/clinical area and instruct the patient on gowning procedures.
Throughout the registration process, the clerical staff must communicate professionally, empathetically, and discreetly, ensuring that they consider the patient’s unique communication needs and any barriers and ensure the accuracy of all information entered into the patient’s chart.
Take Note! — Assessing Falls Risk
A falls risk assessment is usually done for older adults. The most common falls risk assessment is the Morse fall scale. The registration clerk may start the assessment during the admitting process by asking simple questions such as:
- Have you fallen in the past three months?
- Do you feel unsteady when standing or walking?
- Are you worried about falling?
Affirmative answers will be flagged as part of the admission process so that the care team can provide further screening and implement a fall reduction strategy (Medicine Plus, 2021).
Take Note! — Patient Labels
Patient labels are pre-printed sheets of labels containing key demographic, clinical and billing information for the patient. Depending upon the type of configuration, each sheet may include 24-40 labels. When using paper chart forms, the HUC must ensure that a label is affixed to every blank record and that extra labels are stored in the p-Chart to affix to new paperwork as it is added. Pre-printed labels usually resemble this format:
- Last name, First name, Initial (DOB)
- MRN/OHIP number
- MRP/GP
- Admission date
- Allergies
References
Biddle, M. (2015). Maintaining the master patient index: The impact of patient registration processes on data integrity. Applied Research Projects. 32.
Medicine Plus. (2021, September 13). Fall risk assessment. National Library of Medicine.
Thompson, V. D. (2018). Administrative and clinical procedures for the Canadian health professional (4th ed.). Pearson Canada.
Attributions
“person wearing orange and white silicone band” by Jon Tyson; used under the Unsplash license.
medical record number
hospital number
a table or database that includes patient information used in registration and billing processes; each individual patient within the database has a unique identifier
financial number
assesses how likely it is that a patient—usually an older adult—may fall; the Morse fall scale is the most common
hospital-related infections that were not present on patients when admitted; may also be present on patients who have recently been admitted to hospitals or long-term care facilities
pre-printed sheets of labels containing key demographic, clinical and billing information for the patient; affixed to documents in the p-Chart
indicates patient without known allergies or diabetes
indicates patient with known allergies
indicates patient with diabetes; can be used in combo with red if patient with diabetes has allergies
indicates patient with risk of falling; used in addition to a regular armband
