Things to do and say when registering a patient on A&E Web (McKesson)

Registering a patient in PAS\BedWeb\A&E Web seems very straightforward, but it’s not. We are dealing with people and data, and trying to match up details that are often unclear, with existing records that are sometimes incorrect. There are a series of set questions that you need to consider when talking to a patient

Primary Question / What and Why ?
What is your name?
What is your surname?
What is your full name including middle names? / Ask them to spell the surname. You can even spell Smith any number of ways
Ask for their full name. This weeds out people who don’t use their first name, eg George Edward Jenkins may be known round Harlow as “Ted”. This is no use to us; we need full and formal name, in the correct order
Ask them to spell the first name, but don’t accept shortened names. If they say their name is “Tom” ask “Is that Thomas”. Same for Matt or Jackie or Steve or Angie. Ask them to spell it too. We know that there are girls called Charlie, but boys are usually Charles. The reason to be formal is for consistency across the Trust. If everyone asks for the same thing, then we end up with accurate records.
Hyphenated and double-barrelled names require care; if you get it wrong, then staff who subsequently search for that patient record may not find it. If someone says their surname is “Jackson Carter”, then ask “Does that have a hyphen”. When entering double-barrelled names, remember that there is no space between either name or the hyphen – a computer reads a space as a character, and if you enter a space it will cause problems on subsequent searches. For example, enter the name as JACKSON-CARTER
There may also be a problem entering names such as McDonald and MacDonald. Always ask the Macs how to spell their name
Likewise the O’ names – O’Neil, O’Leary etc. 99 times out of a hundred there will be an apostrophe after the O. If you don’t put it there, then finding the patient again becomes very difficult.
Have you ever been treated here before?
Have you had any sort of treatment, including Xrays and at Harlow, Bishops Stortford or Epping?
If you have been here, were you treated under the name you have just given me? / This is the most important question of all. If they have been here before then we have their details. The number of times we are re-registering patients is huge, and costs a fortune to correct.
Be aware that most of the patients are local and many of them will have been born here. Think about babies changing name subsequent to birth and name changes on marriage too – there are lots of people who have been to PAH under different surnames
Process: The A&E front end is not as good as PAS at spotting potential duplicates. Be particularly careful entering the name, and if you are unsure then enter partial details. If you enter ELI SMI in the first name and last name field the result will be a list of all the Elizabeths, Elizabeths, Elizas etc and the Smiths, Smithies, Smithsons etc. A partial search on name is a good start and should be done before entering any other details
What is your date of birth?
How old are you? / This is a key field and it really matters that you check what you have input and you ask the patient for confirmation. Problem is that the field is a little temperamental and the calendar icon is awkward. Enter the date in the string ddmmyy, and then click the mouse into the age field. Check to make sure you have the right numbers in the field. Then confirm back with the patient. If you ask their age, then it should match the age in the (automatically populated) age field. An incorrect DoB field can cause real problems when matching patient against NHS data.
NEVER use DoB as a search for a patient until you have exhausted all the search possibilities under name. There are too many dates of birth entered incorrectly for you to get a clean hit on the patient record you are looking for. If a name search is not giving you what you think you should get, then revert to a DoB search, but be wary of the results
What is your address?
What is your Postcode / This is very important for a number of reasons. It is a field that helps us validate a patients NHS number, which leads to better patient identification, and the reduction in the number of duplicates. Also - you can’t see it in A&E Web - but when viewed in PAS the financial importance is clear. The postcode links to the PCT. If the postcode is correct, then the PCT is correct – when the PCT is correct, we get paid. If you don’t put an address or postcode in correctly, then it messes up the finance
Remember that ZZ99 3VZ is NFA and that ZZ99 3WZ is Not Known. If you just stick in any numbers that come to mind, then staff in other parts of the Trust have to correct it
A list of foreign postcodes is available from PAS if you want to print it out
GP Detail
Who is your GP?
Which Practice are you with? / Critical. Again, it helps with work in Finance, but remember that letters from the Trust go to the GP that you enter in this field. At one time the actual GP was important, and although it still is, it is far more important that you get the Practice correct – then at the very least we are telling the correct Practice about their patient and asking for money from the correct PCT. If the GP has expired, it is imperative that you get a new GP in to this field – if the patient is admitted to PAH as a result of the A&E attendance and manages to get discharged without an active GP then we could lose the payment. Equally, an incorrect GP on an admitted patient means we send the Discharge Summary to the wrong GP and then spend time resending the misdirected post. Getting this right also reduces the likelihood of a breach of confidentiality
Other fields / The fields for Civil Status, Ethnic Group, Religion are all compulsory. Some people object to being asked these questions, but ask them anyway because they are important. The Civil Status helps us with next of kin details. Ethnicity may help clinical staff with diagnosis, and religion may be needed too.
The Title field is not compulsory, but is used on envelopes and letters, and it is reasonably polite to have a salutation on correspondence. For consistency, enter all titles in Capitals.
NHS Number. This is the Trusts primary identifier for patients. It’s a bit unlikely people know their number, but it would not hurt to ask. PAH A&E has a very high percentage of patients with an NHS Number as compared to the rest of the region, and it’s a record worth maintaining
After you have completed these fields, then the patient is registered. What would then be good is to select option 3 from the GP screen and enter the Next of Kin. This is particularly important if you are dealing with a child. Note that the address defaults to the patient’s address. Under Next of Kin name, enter a full name in freetext - entering “Mum” or “wife” is next to useless. Enter a phone number if you can get one.

What do I do if I create a duplicate or spot a duplicate? Everybody creates duplicates. It can’t be helped - the nature of the data and the way we sometimes have to interact with patients makes this inevitable. But what creates a real problem with duplicates is not tackling them as soon as we can. The Trust has dealt with thousands upon thousands of duplicates over the past year, and we need to cut down the duplicates that are created. A&E is the main source of duplicate registration, and although this is expected because A&E are the primary source of registrations, it doesn’t mean we can’t try to improve. If you spot a duplicate, then call the PAS Team on x7982. We will record the numbers and pass them on to the Medical Records Team in the weekly batch.

Registration: Tips and Slips