Back to the floor - For the record
I have done 'back to the floor' sessions previously in case-note digitisation but this time I spent time with the people who deal with the physical record pre- scanning and somewhat complicated by the post-scanning record also! We currently store over 1.5 million records in our libraries in two onsite locations (as well as several offsite storage locations) with 86 staff. You can see from the numbers its’ big business in our organisation!
For this session I was working with the team preparing outpatient appointments. My guide, mentor and all-round chivvyer-upper was Viv and she took me through all the procedures and processes it takes to ensure the right records are in front of the right doctor or healthcare professional for the right patient at the right visit. I cannot imagine how they keep their cool sometimes ....they start off with version one of a 'pulling list' - otherwise known to the rest of us as a list of patients attending clinic on the same day - which is available 14 days before the clinic, version two is made available 7 days before the clinic at which point some patients may have cancelled their own appointment or the hospital may have cancelled it to bring it forward or put it back and at this point completely different patients may have been added to the list. At this stage they get all the labels ready and make sure the original referral letter for new patients is available. The day before the clinic version three is produced and yes, even by this late stage the list can change completely!
The room that we were in was large but had to accommodate 25 staff at any one time. I would say you had to be very friendly with the people next to and behind you ....because you couldn't all stand up and push your chairs back at the same time! I could see that Sam (the manager of medical records) had tried to improve the working environment for everyone but to be perfectly honest we need to spend a bit more money than Sam has in her environment budget to create the space they need even though it will be for a relatively short period of time until casenote digitisation is fully rolled out. While I was based at the workstation I banged my leg three times on boxes and table legs, trapped my finger once between two chairs and cut my finger on a loose staple (that last one wasn't because of lack of space - more lack of concentration!) It was also pretty obvious that they need more data points, label printers that don't break down and computers as the queue to use the ones in the room grew ever longer. Sam told me that the guy who repairs the label printer comes so often he's now invited to the Christmas party and has been to a member of staff's wedding (I made that last one up but she definitely made a joke about the Christmas party!)
Viv took me 'on tour' to look for patients medical records; we went into the basement where literally thousands of notes are filed on shelves from floor to ceiling. Many of the shelves are on moving castors that require a large wheel to be turned in order to move the whole stack safely. Getting between the shelves and looking for records on the lowest shelf in relatively poor light was difficult at times but the people who work there regularly didn't seem to struggle as much as I did. We went to find casenotes in the Plastic Surgery department and over to Rosemere Cancer Centre - often patients’ records won't be in the main library because many of our patients have multiple co-morbidities and have lots of different appointments in many departments. It became very apparent to me just how important it is to track patient's records every time they move. Ours is a vast organisation covering two hospitals and the specialist mobility and rehabilitation centre, not to mention all the clinics we do in other hospitals and centres across Lancashire and south Cumbria - it is critical we always know where records are being taken to. We also visited the coders who were frustrated at records being taken and not tracked because of the impact it has on coding.
Some of the records were simply enormous! I handled one set that was in a large cardboard box and probably a foot above the top of the box as well. The sooner we can scan these, the better! Everyone I met was concerned about information governance and I didn't see anyone leave a computer unattended without first logging out. It's really very reassuring to see policy in action and to know that each person is very clear about their personal responsibility in keeping patients’ information safe and confidential. The next part of my visit was to the room adjacent to the main area - eight people work in here but I was meeting Carol who was responsible for inpatients. She was taking calls relating to emergency admissions, so they could quickly get access to a patient’s records. She told me that I must be a lucky mascot because normally the phone rings incessantly but while I was in there it didn't ring once! I left there to work with Natalie in prepping the clinic to take through to reception which in itself was a task (some of those records are really heavy and awkward!) and about 30 minutes later popped back to see Carol who told me that the phone had rung twice but that really it never usually stopped .....honestly! I believe her!
There are a few things that we have already set in train following my visit that are mostly environmental like new desks, chairs, more computers and printers. Normally I would write a list but there’s quite a lot to do and would take up most of the page! So what I’ll do is take some before and after pictures so you can see how we’ve responded
Many thanks to everyone for being so accommodating and good fun! You do a great job in not-great surroundings and I hope we can improve the area for you all.
PS Carol - has that phone rung yet?!