Walk-in patients who arrive during an EHR outage are one of the most practically challenging scenarios for registration and clinical staff. Unlike established patients whose demographic information, MRN, and medical history are already in the downtime workstation from the pre-outage HL7 feed, a new walk-in patient has no existing record in the system. They are, from the downtime workstation’s perspective, an unknown. How that unknown gets resolved determines whether the patient receives safe, accurately documented care, or whether their encounter becomes a gap in the record that creates problems for billing, clinical continuity, and patient safety downstream.
The good news is that dbtech is specifically designed to handle this scenario, and the process for registering an unregistered walk-in during a downtime event is structured, electronic, and fully reconcilable with the EHR after recovery.
How New Patient Registration Works in dbtech During Downtime
Before a downtime event ever begins, dbtech is pre-loaded with a bank of reserved downtime encounter numbers and medical record numbers that are specifically set aside for use during outages. These numbers are coordinated with the EHR in advance so that they do not conflict with any MRNs or encounter numbers the EHR will generate when it comes back online. When a walk-in patient arrives during a downtime event, registration staff use one of these pre-assigned numbers to create a new downtime record for that patient.
The registration process for a new walk-in using dbtech includes the following steps:
- Staff assign the patient a downtime MRN and encounter number from the pre-loaded bank
- Demographic information including name, date of birth, address, and contact details is entered directly into the downtime workstation
- The patient’s photo identification and insurance card are scanned directly into the downtime system and attached to the downtime record
- A barcoded wristband is printed using the downtime MRN, so that the patient has a scannable wristband from the moment they are registered rather than a handwritten one
- Consent forms and any required intake documentation are completed electronically using dbtech’s eForms and attached to the downtime record
- The downtime registration record captures all of the information that would normally be entered at registration so that the post-outage reconciliation process can match the downtime record to the EHR record
Patient Safety During an Unregistered Walk-In Encounter
The barcoded wristband is the most critical patient safety element for a walk-in patient registered during downtime. Without it, every downstream clinical workflow that depends on barcode scanning for patient identification, including medication administration, specimen collection, and procedure verification, is degraded. A handwritten wristband cannot be scanned. A patient without a scannable wristband is a patient at elevated risk for identification errors throughout their care episode.
dbtech’s ability to print a barcoded wristband for a new patient during downtime, using a pre-assigned downtime MRN that links back to the EHR after recovery, means that the barcode scanning workflow continues uninterrupted from the moment of registration. This is one of the most important patient safety capabilities in the entire downtime solution, and it is one that paper-based backup procedures cannot replicate.
The Joint Commission’s National Patient Safety Goals require a two-identifier patient verification process before medication administration, specimen collection, and other clinical activities. Barcoded wristbands are the primary mechanism most healthcare organizations use to meet this requirement. dbtech ensures that requirement is met for walk-in patients registered during a downtime event, not just for established patients whose wristbands were printed before the outage began.
What Happens to the Walk-In Record After the EHR Is Restored
When the EHR comes back online, walk-in patients registered during the downtime period are reconciled into the EHR using a structured process supported by dbtech’s bi-directional HL7 interface. The downtime registration record, including the demographic information, scanned documents, completed eForms, and assigned downtime numbers, is exported from dbtech and matched to the newly created EHR record for that patient.
The pre-coordination of downtime MRNs and encounter numbers with the EHR is what makes this reconciliation clean. Because the numbers were reserved in advance and are known to both systems, the matching process is systematic rather than a manual effort to figure out which downtime records correspond to which EHR encounters. To learn more about the full post-outage recovery process, see our post on reconciling downtime data back into the EHR after an outage.
Planning for Walk-In Volume During an Outage
Registration teams should include walk-in volume planning as part of their downtime procedure preparation. Specific considerations include:
- Confirming that the pre-loaded bank of downtime MRNs and encounter numbers is sufficient for the expected walk-in volume during a multi-hour outage
- Establishing a tracking log for all downtime numbers issued so that the reconciliation team has a complete accounting of every new patient encounter created during the outage period
- Briefing triage and registration staff on the walk-in registration workflow before an outage occurs so that the process is familiar when it is needed
- Identifying the department responsible for overseeing downtime number allocation and preventing duplicate assignments
To see how dbtech handles walk-in registration in your specific environment, request a demo or contact our team to walk through the workflow in detail.