Problems Related to Medical Records and Management

Introduction

A patient complaint in medical records is one of the best opportunities for turning an unhappy patient into a loyal customer. Even the most dissatisfied patient can become an ambassador, winning new patient for the institution by word-of-mouth advertising. Only a few patients will complain . The majority will not return to the hospital and will tell others of their bad experience. The simple fact is that one may be pushing profits out of the door in the abscence of effective complaints handling policy.

So, through resolving a complaint efficiently and fairly, the hospital retain the customer's loyalty and potentially gain new customers through good feed back. Take time to handle complaints when they are first made as, prompt action will more likely satisfy the patients. The faster a complaint is resolved, the less time you'll need to spend on it.

You may not believe the patient's complaint is justified but remember that, although they may not be 'right' in your opinion, they are telling you because they are unhappy. Their complaint is an opportunity to retain the patients.The situation may be difficult if the patient is angry or has an irritating manner, or if their complaint seems trivial to you, but getting angry yourself will only make it worse.

Find out the exact problem. Listen carefully to what the patient is saying, empathise with them and make sure you understand by checking it out with them.

The studies which are carried out in this chapter will be a supportive version in solving the problem related to medical records and the method of managing them.

How to detect a wrong - filed medical record?

In spite of the techniques adopted to file the records properly, there are several instances of human errors in filing the records.

• When a record is not found in its original place, usually the medical records team is forced to search for the record which is misfiled thereby bringing the routine affairs to a standstill.
• In such a situation the M.R.No., of the misfiled records as well as the medical records number similar to the number of the misfiledrecord are noted.
• For example, if the misfiled number is 534607, the number similar to this will be 534067 or 534670 or 536407 or 536470 or 534507 or 534807.
• Thus the misfiled record is searched in all these locations. Apart from this, all medical record number serial from 534000 to 535000 will be also searched if the record is not traceable through the first method.
• If the record is still not found, a list of all revisit patients visited on the day can be taken and the missing record can be searched in between each and every record filed on that day.
• Possible chances are always there to file two medical records keeping one into another, thus by misfiling one of the two records.
• At times it is also possible for the filing assistant to do a wrong filing when she is doing the filing job constantly for more than two or three hours. Continuous eye strain may also cause a wrong filing.
• Despite all the above measures, if the misfiled medical record is still not found, all medical records available in the particular shelf should be removed and searched to find the possibility of medical record lying in between any one of the medical records.

Finding a missing medical record

Despite the extensive measures adopted to have good control over medical records, some records will be missing. This could be due to non-receipt of medical record from the clinic or not filing the medical record in its appropriate place.

• Under these circumstances, when a doctor insists on obtaining the original record for rendering care, the medical records assistant should inform the doctor first about the non-availability of medical record.
• Due care should be taken by the medical records assistant to search for the original record.
• Patient can be enquired about the clinic he has visited, the investigations advised and referred to any other clinic during his last visit.
• Possibilities are always there to find the record in any other clinic due to an awaited lab test or any other procedure to be performed upon the patient.
• If the original record is not found within 15 minutes from the time of registration, necessary steps should be taken to open a duplicate record thus, by avoiding the patient to wait in the registration area for a longer duration.
• Thus a duplicate record can be created with the same medical record number and with the sociological data of the patient. The word "Duplicate" should be written in the right side top corner of the record.
• The duplicate record thus created should be recorded in a note book.
• This will help the medical records technician to remember the number and search the same with the help of the medical records assistant during the leisure hours.
• When the original record is traced, the medical records assistant should incorporate all the forms found in the duplicate record to the original record.
• Before filing the original record in its place, the name and medical records number entered in the duplicate search note book should be deleted.
• It is always advisable to inform the patients telephonically or through a letter when the original record is found.

Patient having multiple records

The medical records technician should be very careful in avoiding multiple records for a particular patient by taking necessary steps to eliminate duplicate records and ensuring each patient to have one medical record only.

But, without the knowledge of the medical records staff patients may tend to register newly during every visit to the hospital. The reason is patients feel very desperate to inform the staff that they last their identity card. In such a situation, it becomes necessary to retain one record by cancelling the others.

The appropriate procedure is to retain the new record. The remaining records have to be cancelled and given cross-reference numbers. All the documents in the cancelled records need to be moved into the retained record. The cancelled empty folders with the cross-reference numbers should be placed in their respective area. Any cancelled record number should never be allocated to a new patient.

Patient crowd management

The primary factor in ensuring a safe and comfortable environment for managing patient crowd is planning. Most of the hospitals may not experience this situation as they see only a very limited number of out-patients. But, there may be a situation when you find a large crowd of patients after a festival or a monday morning when you find it difficult to manage the crowd.

Many hospitals train their crowd management personnel and provide orientation manuals for staff and security. Whenever large crowds gather the processing of those patients must be organized, orderly and disciplined. Using a queue means having control over a large crowd. It also prevents potential hazard of crowd developing a sense of urgency and rush towards an entry point. This sense of urgency or anxiety is the crucial factor that must be removed.

The patients can be well informed about the present situation through public address system. Creating awareness among patients will reduce their tension there by preparing their mind about the actual time taken to reach the counter.

During power shutdown or when system fails

• An uninterrupted power supply (UPS) provides constant power to a computer system when power fluctuation or power loss occurs. The key to recovery from a systems failure is preparation.
• If you have already taken steps towards prevention of power related problems and arranged for continued working of systems, you will be in a much stronger position to handle the unexpected.
• Perform a risk analysis. This can be a sophisticated and extensive exercise, but it is essential to establish the importance of each system or system element. Work out what could stop them operating. Implement appropriate controls to minimize the disruption caused by any untoward event.
• Take regular backups of information and store them away from the system. Establish how long your hospital can tolerate a system failing (a day, a week?) and make sure your backups allow you to recover before that time elapses. If you hold sensitive information, remember to apply appropriate security to your backup media.
• Make sure you have access to alternative machines to run your systems and hold your data. Make sure all staff know what to do in an emergency.

Summary

There are large number of issues in a hospital that result in dissatisfaction of patients and their visitors. A number of such issues continue happening without the notice of management. The nurse, medical records staff and all others who come in contact with patients and their attendants need to be sensitised to behavioral issues. The management should make it clear that patients are very important to the hospital and misbehavior or maltreatment would not be acceptable. However, due care should be taken to maintain and promote self-respect and dignity of the staff. A vigilant Hospital Management professional can identify most of these issues and can take corrective actions. Attending the patient promptly and improving communication is the key to improving patient satisfaction. Whenever it is not possible to retrieve a medical record promptly, inform the reason for delay and when it will be possible to provide the record. Merely satisfying the patients may not be sufficient to gain his loyalty. The providers may have to exceed the expectations of the patients.

Key points to remember

• Patient cannot evaluate the professional quality of care, but they do evaluate the food, linen and housekeeping services and behavior of the staff
• Patient complaints tell a health care organization how to improve services; they are most efficient and least costly way of getting information from patients and understanding their expectations about the services you offer
• As a general rule, each patient should have one medical record and one medical records number
• Take time to handle complaints when they are first made, prompt action will be more likely to satisfy the customer
• The key to recovery from a system's failure is preparation. Take regular backups of information and store them away from the system
• A practical demo can be arranged as how a UPS works and how the system fails and the medical record assistants can be explained as how to overcome such a crisis
• The medical record assistants can be instructed as how they should manage the crowd and they can be practically exposed to manage them

Student exercise

Answer the following

1. Public is becoming more and more conscious of their rights and privileges and are expecting a higher standard of service. What method you will adopt to give a quality service to them?
2. An author has written that "patients" complaints are the biggest gift to the organisations". How will you react to the statement?
3. Describe the various methods of finding a missed or wrongly filed medical record? What steps will you take to communicate to the patient?
4. If a patient absconds from the ward what steps should be taken regarding the legal proceedings?
5. Explain the steps to be taken during a system failure or when the UPS is down? What steps you will take to avoid it recurrences?