by Cindy A. Abole, Public Relations

Negotiating the admissions process maze is not a pleasant prospect for a person who needs to be hospitalized, nor for a family member who longs to be by a loved one’s side.

The MUSC Patient Access Services group has learned to skillfully integrate good customer service, reliability and effective communications to help make the first stages of a hospital stay less confusing and more comfortable for patients and families.

Tapped as South Carolina’s lead teaching hospital and referral center, MUSC’s reputation as a major medical center is easily reflected by a rising number of patient admissions and bed occupancy rates.

“We want to let employees have a better understanding of what’s involved in patient discharges and admissions for bed control,” said Sue Pletcher, director of Patient Access Services who recently coordinated a hospital open house for staff and employees.

Recent reports conducted by Patient Access Services, verify a steady increase in patient admissions at MUSC within the last few years. Since early 1998, the total number of unscheduled admissions has risen to include 51 percent of total admissions.

“Unscheduled admissions have an impact on support departments such as Environmental Services and Dietary, as well as in the clinical areas,” Pletcher said. “Frequently, these patients are quite ill and need a bed as soon as possible.”

Pletcher is quick to praise her crew and the work of other hospital personnel who must remain flexible and respond quickly to work changes associated with room “turnover” and new patient admissions.

“No one understands the volume of people that goes through admissions and the registration process,” said Cindy Williams, patient registration manager.

Bed Management

The admissions process begins at Bed Management, otherwise known as “command central.” This division of Patient Access Services oversees bed placement of all patients. In addition, the department monitors patient transfer requests, discharges and admissions throughout a 24-hour period.

A team of nurses communicates directly with physicians, charge nurses and nurse managers, plus staffs at outpatient clinics, emergency department, referring hospitals and physician’s offices to provide daily updates for incoming and existing patients. Their work is coordinated through a huge bed board and wall charts, which organizes patients by color-coded name plates and activity reminiscent of its own mission control area.

Although MUSC manages 596 hospital beds, its record high occupancy and turnover rates make it is difficult to immediately assign a patient to a bed. Colored bed plates help identify patients. For example, surgery plates are highlighted brown; cardiology, grey; transplant, purple; gynecology, white; pediatrics, pink and blue.

Sometimes the number of admissions are so overwhelming that some units run out of bed space and are forced to assign patients to alternative unit locations. For this, good planning is a necessity. On occasion, five beds are assigned for adult medical/surgery patients in the Children’s Hospital.

“Even though Bed Management tries to place patients on the designated service floor, this is not always possible,” Pletcher said. “Bed Management tries to rotate admissions among the most appropriate patient care units, so that one area does not get too overwhelmed. Still things can get quite hectic.”

Registration

Generally, patients are admitted through central registration. Unscheduled admissions usually come from the emergency department, ambulatory surgery, same day surgery and other clinics. Using the Medical Center’s Keane computer system, patients begin the registration process. As they provide demographic information, patients are also advised on other issues including advanced directives, patient’s rights, confidentiality, etc. They try to obtain accurate information and verifications so the patient does not have problems with the insurance company covering the costs of hospital admission.

Patient Financial Counselors

Next, a patient is assigned an account and medical record number which will be used for identification and billing. Finally, a card or patient stamp plate is created which provides basic information and the healthcare provider. It is forwarded to the nursing unit and used for everything from X-rays and drawing blood to providing supplies throughout a patient’s stay.

It is the job of patient financial counselors to coordinate billing for each patient. Their duties include verifying insurance benefits, requesting medical records, performing quality checks to assuring accurate billing and verifying a patient’s demographic information.

Utilization Review

Finally, nurses who are members of the utilization review team provide follow-up work by obtaining initial authorization of medical necessities from various insurance carriers. They also evaluate medical care performed by reviewing charts, reports, consults, progress and nursing notes. This information is vital to the staff’s discharge needs and verification for health insurance requirements.

“The open house provides a better perspective of a large ongoing process,” said Patrick Harrell, an R.N. from STICU. “Going through this, (open house) you understand and get a better perspective of the types of frustrations and juggling that goes on between floors.”

MUSC occupancy rates in 1997-98 show the highest jumps in patient admissions affecting hospital areas such as pediatrics and the MUSC Burn Center. Other units showing large occupancy gains include obstetrics and cardiology/cardio thoracic surgery and vascular surgery.

Occupancy rate information can be used as a yardstick to measure MUSC’s presence and effectiveness by tracking referral patterns shared by Lowcountry and regional interns, residents and specialists. For example, MUSC’s neonatology area, a 38-bed unit, showed an increase of 14 percent of its patient occupancy rate since 1996. Its reasoning reflects MUSC’s capability for handling more high risk neonatal patients than other area hospitals.

“All this makes a difference in the long run,” Pletcher said. “The information we track helps us improve ourselves in certain areas and matters a great deal in receiving proper certification and review.”

Admissions research revealed daily and monthly unscheduled hospital admissions patterns which are useful in staff planning and preparation. For example, Mondays were noted to be the busiest day for all unscheduled admissions. From 1997-98, October and March showed the highest gains in total hospital admissions.

Kim Garcia-Eubanks, an admissions counselor with Patient Access Services, acknowledged the positiveness of providing the recent open house such a service. “It’s a good chance for staffers like myself to see what we do and understand our roles in the ongoing process,” said Garcia-Eubanks.

“We’re constantly getting more or new information,” Pletcher said. “It’s very important that we keep our staff updated from time to time.”