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Q: We’re looking into internal training initiatives for our registration staff to help clean up data collection. Can you provide some ideas on where to start?

Patient Financial Services Weekly Advisor, April 30, 2004

A: In order to determine how to improve the quality of registrations, it is important to thoroughly analyze the data. Not only do you need to examine total volume of errors, but you must also analyze by type of error and by location or department in which the errors occurred. Eventually you want to calculate errors by the registrar, but this is less important in the beginning because you are trying to assess where deficiencies are and what may be causing them.

In your analysis, look at preventable v. unpreventable errors. Not everything that prevents a bill from being generated is a preventable error. There are times when the information is unavailable or incomplete, and the registrar must complete the registration with the available data. The setting of service becomes important here-you can't hold the emergency trauma center registrars to the same standard as outpatient registrars because the conditions are completely different.

Another step is to determine whether you can make system changes that would prompt registrars to ensure certain elements are collected (e.g., a user-friendly insurance file that makes it easy for the registrar to select correctly, fields that are coded as mandatory to prevent skipping, formatting rules that ensure the correct number of characters, etc.).

Once you've done all this, focus on problem departments or employees and reeducate them based on the findings for areas of weakness. Then establish thresholds for each area and continue to monitor.

An important follow-up initiative is to evaluate the orientation process to look for deficiencies or inconsistencies in the initial training program. By correcting the errors, you can be certain everyone is at least starting on an equal playing field and the tools and personnel used for training are appropriate. Most people want to do a good job and if given proper training and tools, they will perform up to the standard.

This question was answered by Joyce Sourbeck MS, RN, director of patient accounts/patient registration at Abington (PA) Memorial Hospital.

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