PUSIFOKES HARINI DESEMBER 2010

HALLO WELCOME TO PUSINFOKES HARINI

DECEMBER 2010

Rahasia Kehidupan dari Sperma

Vera Farah Bararah

img
(Foto:thinkstock)

Jakarta, Sperma adalah sesuatu yang mengagumkan dan banyak rahasia yang belum bisa diketahui. Salah satu rahasianya, sperma hanya bisa berenang maju dan tidak bisa mundur. Apalagi rahasia siklus kehidupan dari sperma?

Sperma memiliki siklus kehidupan tertentu mengenai berapa waktu yang dibutuhkan agar matang dan juga berapa lama sperma bertahan di dalam tubuh perempuan. Hal ini bisa membantu seseorang memahami lebih lanjut tentang spema.

Seperti dikutip dari Foxnews, Sabtu (4/12/2010) Dr David Shin, kepala pusat kesehatan seksual dan fertilitas di departemen urologi dari Hackensack University Medical Center di New Jersey menuturkan beberapa rahasianya:

1. Sperma diproduksi di testis dan membutuhkan waktu selama 10 minggu untuk menjadi matang. Sperma yang matang ini bisa menunggu selama dua minggu di daerah yang disebut epididimis (waduk penyimpanan sperma), organ ini berada di atas testis.

2. Berat dari sperma manusia sebesar 55 mikron (mikrometer atau sepersejuta meter).

3. Sperma ini sendiri berasal dari bahasa Yunani yang berarti ‘biji atau benih’, yang hanya bisa berenang maju dan tidak bisa mundur.

4. Bentuk sperma yang normal memiliki kepala dan ekor, sedangkan yang abnormal memiliki dua kepala atau dua ekor.

5. Laki-laki yang sehat akan memproduksi 70-150 juta sperma per hari. Sperma ini terdapat dalam air mani yang mana rata-rata volume air mani normal yang dihasilkan pada ejakulasi adalah 2-5 ml (setengah sampai 1 sendok makan ukuran Inggris).

6. Dari setiap cairan semen (air mani) hanya terdapat sperma sebanyak 5 persen. Kebanyakan cairan semen ini terdiri dari cairan yang memberikan nutrisi serta menjadi pelindung pada saat sperma masuk melalui saluran reproduksi perempuan.

7. Sperma bisa bergerak rata-rata sejauh 1-4 milimeter per menit. Untuk menempuh perjalanan menuju sel telur di dua tabung falopi, sperma membutuhkan waktu 45 menit – 3 jam.

8. Dari sperma yang keluar saat ejakulasi, hanya sekitar 25-50 persen saja yang bisa bergerak maju dengan baik, dan terkadang ada sperma yang membutuhkan waktu selama 3 hari untuk mencapai sel telur.

Sperma yang sudah masuk ini bisa bertahan hidup sampai 5 hari di dalam rahim perempuan. Kondisi ini membuat seseorang bisa hamil setelah beberapa hari melakukan hubungan seksual.

9. Sperma ini mengandung Y dan X, sperma Y untuk membuat anak laki-laki dan berenang lebih cepat karena beratnya lebih sedikit dibanding sperma X (untuk membuat anak perempuan).

10. Untuk meningkatkan pergerakan dari sperma agar bisa berenang dengan cepat dan baik adalah mengonsumsi banyak buah-buahan dan sayuran, mengurangi stres, berolahraga secara teratur, memperhatikan berat badan, menghindari penggunaan narkoba dan membatasi asupan alkohol.

Vitamin C Sehatkan Prostat

Vera Farah Bararah

img
(Foto:thinkstock)

Jakarta, Prostat yang baik dan sehat merupakan hal penting bagi laki-laki, karena prostat yang tidak sehat bisa menimbulkan berbagai masalah. Salah satu cara untuk menjaga prostat tetap sehat adalah dengan konsumsi vitamin C.

Prostat adalah kelenjar kecil sebesar buah kenari yang membungkus bagian atas uretra. Prostat ini bertugas mengeluarkan campuran cairan dan enzim yang diperlukan oleh sperma agar tetap sehat.

Berbagai penyakit bisa muncul jika prostat seseorang tidak sehat, seperti gangguan pembesaran prostat atau yang paling parah adalah kanker prostat. Selain itu gangguan pada prostat juga akan berdampak timbulnya masalah dalam berkemih (buang air kecing).

Seperti dikutip dari Livestrong, Sabtu (4/12/2010) mengonsumsi vitamin C baik melalui makanan, minuman atau pun suplemen bisa memberikan keuntungan terhadap kesehatan prostat dalam beberapa cara, yaitu:

1. Mengurangi risiko kanker prostat
National Cancer Institute menuturkan bahwa seseorang yang mengonsumsi sayuran kaya vitamin C seperti brokoli cenderung memiliki risiko lebih rendah untuk mengembangkan kanker prostat.

Selain itu Prostate Cancer Foundation melaporkan konsumsi 400 gram brokoli per minggu bisa membantu menghentikan pertumbuhan tumor pada kanker prostat.

2. Mengurangi risiko pembesaran prostat
Mayo Clinic menuturkan konsumsi vitamin C dalam sayuran dapat menurunkan risiko terkena pembesaran prostat. Jumlah harian vitamin C yang direkomendasikan untuk laki-laki dewasa adalah 90-2.000 mg per hari.

Vitamin C diketahui melimpah dalam sayuran brokoli, kembang kol, kangkung, paprika dan kacang polong.

3. Membantu melawan bakteri prostatitis
Para ilmuwan dari University of Maryland Medical Center telah mengamati bahwa vitamin C dapat menghentikan pertumbuhan bakteri yang bisa menginfeksi prostat.

Kondisi ini dapat menyebabkan peradangan (inflamasi) prostat yang dikenal dengan nama prostatitis. Beberapa dokter menyarankan untuk konsumsi 500 mg vitamin C per hari untuk membantu memerangi prostatitis.

Selain mengonsumsi vitamin C, sebaiknya diimbangi dengan olahraga teratur, mengurangi koleterol dan asupan lemak, mengurangi minuman yang diuretik seperti kopi atau teh serta melakukan hubungan seksual secara teratur.

the end @ copyright dr Iwan suwnady 2010

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London Collage ‘s National Standars for the Structure and content of Medical record

National Standards for the structure and content of medical records.

The Medical Record Keeping Standards Programme of the Health Informatics Unit at the Royal College of Physicians, London.

Prof. Iain Carpenter, Health Informatics Unit, Royal College of Physicians, London/Centre for Health Service Studies, University of Kent, Canterbury

Mala Bridgelal Ram, Health Informatics Unit, Royal College of Physicians, London

Professor John Williams, Director, Health Informatics Unit, Royal College of Physicians, London/ School of Medicine, Swansea University

Patient medical records serve two principal purposes. The first is to support direct patient care by acting as an aide memoir for clinicians and supporting clinical decision making. The second is to provide a reliable source of data to support clinical audit, research, resource allocation and performance planning.  In the UK, the link between the two is the coding of diagnoses and procedures during a hospital stay that is then returned centrally for analysis and publication in the Hospital Episode Statistics.  We describe how the Health Informatics Unit at the Royal College of Physicians in London has co-ordinated the development of nationally agreed standards for the structure and content of medical records that have been agreed for all hospital specialties.

The programme emerged from a project aiming to compare the performance of gastro-enterology services between hospitals by analysing Hospital Episode Statistics (HES).  The study concluded that it was impossible, possibly because of errors in the coding of diagnoses and procedures imprecisely recorded in medical notes.  An audit of 149 sets of medical notes from 5 hospitals found that there was such variability between hospitals in how records are structured and organised that a comparative audit was not possible.   A subsequent literature search for evidence of the benefits of standardised medical notes, though patchy in coverage, demonstrated benefits to patient safety and care outcomes, as well as likely improvement in ease and accuracy of clinical coding.  This initiated the Record Standards programme at the Health Informatics Unit (HIU).  The national programme to develop an Electronic Patient Record (EPR) for the National Health Service (NHS) in England gave added weight and urgency to the work, as an EPR requires standardisation of data, ideally reflecting best clinical practice rather than requirements of a computer system.

The goal was to develop consensus and evidence based structure and content standards for medical notes that would reflect professional best practice and be acceptable to all medical and surgical hospital services.

Our first step was to draft content and process standards for medical records from both the literature review and a review of standards published by medical professional bodies.  The standards covered generic issues applicable to all medical notes as well as headings to standardise the structure of admission, handover and discharge records.  The HIU separated the generic and content standards and consulted widely, seeking the views of practising doctors and professional and policy bodies.  Generic Medical Record Keeping standards were published by the College in 2007[1].

The development of the admission, handover and discharge record keeping standards started with a poll of practising hospital doctors to gauge the enthusiasm for standardising notes structure.  The question asked was ‘Should the same, standardised headings be used in the proforma for acute medical admissions in all NHS hospitals?’.  In the first of these, conducted by Doctors.net, 2:1 responded in favour, a second poll, of Members and Fellows of the RCP found 4:1 in favour.  Both polls were closed at 1,000 responses (Carpenter et al, 2007). 

With evident support for the proposal confirmed, examples of admission clerking documents from 36 NHS hospitals were used to produce draft headings which were then revised in a series of workshops and then put out to consultation in on-line questionnaire.  The workshops and on-line questionnaires included patients and carers from the RCP Patient Carer Network.  Over 3,000 doctors responded to the questionnaire and contributed over 1,500 written comments.  Of those who responded to the questionnaire, over 90% were in favour of a common structure for the whole NHS.

A further series of workshops and an updated literature review developed headings for use in documents to support handover between medical teams and in discharge documents for when patients leave hospital, the latter with specific input from General Practitioners in primary care.  The on-line handover and discharge consultations each generated around 1,500 completed questionnaires.

At the same time, the Presidents of the all the UK Medical Royal Colleges and specialist societies were contacted and asked to identify nominees who would examine, with their colleagues, the headings for the different types of records from the perspective of their own specialty.  Their responses were fed into revised headings which were then used to structure paper proformas to test the headings in practice.  The product of the exercise was piloted in hospitals [admission (10), handover(11) and discharge(8)], the discharge summary pilot included GPs who received discharge summaries using the standardised headings.

On April 17th 2008, the final revised standards were ‘signed off’ by the Academy of Medical Royal Colleges, attended by the Presidents from all colleges, including surgical, mental health and child health.  They were passed as fit for purpose with observations from psychiatry and paediatrics that although the information that they required was different from and additional to that covered by the standardised headings, their requirements could be accommodated within the proposed structure standards.

The standards have now been submitted to NHS Connecting for Health which is responsible for the development of the EPR in England.  Work on definitions that will meet the rigorous requirements for IT implementation is underway. Once completed they will be submitted to the NHS Information Standards Board for Health and Social Care following which all IT system suppliers will be required to use them for their EPR solutions.  Many hospitals and IT suppliers are already implementing them in both paper and electronic format.

The project has been enthusiastically received by a very wide range of organisations including the IT industry which see them as the means for rationalising their clinical information system applications.  The NHS Litigation Authority, which provides the clinical incident indemnity for NHS providers, are incorporating them into their Risk Management Standards for providers and the NHS Care Quality Commission who register all NHS providers will reference them in their standards required for registration.  They are being incorporated into the medical undergraduate and post graduate training curricula and will likely be referenced in the General Medical Council ‘Tomorrow’s Doctors’ standards document that describes the standards for knowledge, skills, attitudes and behaviours that medical students should learn at UK medical schools. The standards are recommended for use in IT systems in Scotland and are being introduced in Wales.

The NHS Digital and Health Information Policy Directorate has published a two part clinician’s guide to the standards. 

Part 1 describes the rationale for the process of developing and introducing the national professional record keeping standards.  It also lists the expected benefits from their introduction.

Part 2 contains the Generic Medical Record Keeping Standards and the structure and content standards for admission, handover and discharge documents.  

The Guide can be downloaded as pdf’s or free hardcopies ordered on line at : www.rcplondon.ac.uk/clinical-standards/hiu/medical-records/Pages/clinicians-guides.aspx


[1] Carpenter, Iain; Bridgelal Ram, Mala; Croft, Giles P; Williams, John G, 2007. Medical records and record-keeping standards. Clinical Medicine: 7(4):328-331

Modul Pelatihan Praktisi rekam medis:”Administration and mangemenent Health Record Departement”

Education Module for Health Record Practice based on ihfro modul

UNIT 6    ‑      ADMINISTRATION AND MANAGEMENT OF THE

HEALTH RECORD DEPARTMENT

 

The health information management/health record professional must meet the leadership challenge in his/her quest to develop an efficient and effective health record department.  The management of a health record department involves carrying out the basic management functions of planning, organizing, human resource development, directing, and controlling.  This unit introduces the participant to the management process and its application to the management of the health record department of a health care facility.

OBJECTIVES:

At the conclusion of this unit the participant should be able to:

     1.    state four basic management processes and discuss each in relation to their role as a health information management/health record professional

2.    draw an organization chart for the facility in which they work and for the health record department

3.    draw a flow chart to indicate the flow of activities within the health record department

4.    write a job description for each position within their department

5.    illustrate the ability to plan for recruitment, selection and training of health record staff

6.    solve a problem from within the health record department using the steps as set out in this unit.

THE MANAGEMENT PROCESS

The management process involves planning for the future, organizing and developing both human and material resources. It also includes directing individuals or groups to assist willingly and harmoniously in accomplishing the objectives of the facility and controlling the efficient use of resources in achieving those objectives.  These processes can be expanded as follows:

A.  PLANNING

1.   This is the process by which an organisation, facility or sub‑section of a facility, such as the health record department attempts to plan effectively for the future. It includes:

  • establishing objectives and selecting future courses of action

 

  • developing assumptions about the expected future environment in which goals are to be met for instance, a manual or automated environment

 

  • identifying and selecting alternate courses of action which are available to meet the set objectives

 

  • initiating activities within the department which will be necessary to translate plans into action, and

 

  • critically reviewing and evaluating the outcome.  That is, were the planned objectives achieved, if not, why?

 

2.   The planning process for all health information management/health record professionals therefore would be to:

  • set achievable objectives relative to the perceived requirements of the department

 

  • examine the present environment and forecast changes that are likely to influence the department in accomplishing the objectives. With the ever increasing developments in technology, health information management/health record professionals must be alert at all times to technological advances, particularly to computer applications in health care

 

  • identify alternative courses of action, evaluate these alternatives in light of previous assumptions made, and then select the course of action, which, after careful deliberations, appears to be the one which will best suit the department’s requirements. This is part of the decision‑making process in management

 

  • implement the plans with check points to indicate progress during implementation

 

  • evaluate the implemented plans with regard to effectiveness, efficiency and achievement of the department’s objectives (Huffman, 1990).

 

Planning at all levels provides direction and a sense of purpose.  It helps health information management/health record professionals cope with change and contributes to the performance of other management functions.

Planning the physical layout of the health record department is discussed in Unit 8.

B.  ORGANIZING

This is the process by which employees in the health record department and the jobs they do are related to each other. It consists of dividing work among groups and individuals and providing the coordination required between individuals and group activities. This is often referred to as the division of labor.

Organizing also involves the establishment and recognition of managerial authority.

Individual work tasks must be organized into distinct jobs. This is part of what is normally referred to as job design.

1.   Job design, job analysis and work satisfaction

Job design involves specifying job content, work methods used for the job and the relationship between and among individual jobs within the department.

Each job should be assembled into work units within the department.  In turn, the combination of work units within the department must be logically combined to form an overall organisational framework.  And finally, the design of individual jobs and work units within the department, as well as the overall framework of the facility must be related to the environmental influences within the community.

Once jobs have been defined, further information relating to the proposed content of each job should be collected.  This process is called a job analysis and will help the health information management/health record professional determine the skills, knowledge and abilities required to do the job and at the same time clarify lines of responsibility and authority.  When working through this process, it is important to remember that job content will alter with various changes in technology and the health information management/health record professionals must predict, wherever possible, for future changes.

This identification of the work to be performed in each job provides an extremely important basis for planning personnel requirements.  Because of its importance with regard to recruiting and selection, a job analysis should describe not only content, but also specifications.

If the health information management/health record professional is involved in planning a health record department for a new hospital, he or she will rely heavily on their skills and knowledge of health record management, which will enable them to design the anticipated jobs and conduct a job analysis.  If the department is being redesigned in an existing hospital, the health information management/health record professional will need to analyze existing jobs within the old department and predict future changes.  The tools used in the second case could be a combination of observation and an interview with each staff member.

When organizing the work within a health record department the following should be kept in mind.

a)   Job description and specification

Job analysis will provide two types of information (i) a job description and (ii) a job specification.  Job descriptions actually describe the characteristics of a job.  Job specification will indicate the skills required for each job, e.g. typing and transcription.

b)   Improving work satisfaction

How to induce employees to perform work that is boring and unsatisfying is a matter of concern to employers.  The subject of work satisfaction is an extremely complicated one that defies any simplistic explanation or solution.  There are many variables that help to determine whether or not work in a particular job will prove satisfying to a particular employee performing it.  These variables include:

i)   Variables relating to the work of an employee

Variables considered to have an effect upon the satisfaction to be derived from a job include:

  • variety (tools, equipment, activities and workplace)

 

  • autonomy (independence and control in performing job)

 

  • interaction (number and types of inter‑relationships)

 

  • knowledge and skill (time required for proficiency)

 

  • responsibility (closeness of supervision and cost of mistakes)

 

  • task identity (how one’s contributions add to the total effort)

 

  • feedback (being kept informed)

 

  • pay (wages and fringe benefits)

 

  • working conditions (physical work environment)

 

  • cycle time (time required to perform a unit of work)

 

   ii)      Individual differences among employees

A major difficulty in determining how to increase job satisfaction stems from the individual differences among employees.  Differences in abilities, backgrounds, and social conditioning affect the specific psychological need patterns of employees and the specific returns that each may seek from work.  As a result of these differences, work that is boring, repetitious and unchallenging to one individual may be satisfying to another.  Methods used to increase satisfaction, therefore, must take into account not only the structure and working conditions of jobs, but also the needs of specific individuals.

      iii)        Differences in abilities

Employees who have the ability to perform their jobs well are more likely to gain satisfaction from their work.  Jobs, however, must provide employees with the opportunity to utilize their abilities to the fullest extent. Otherwise, under-utilization can be a source of dissatisfaction.

  iv)      Differences in attitudes and personnel adjustment

Employees who are well adjusted emotionally are more likely to be satisfied with their job situations than those who are not. Furthermore, if dissatisfaction stems from causes within the individual, it is not likely to be reduced significantly by changing the job design or work environment. Neither are these individuals likely to resolve their internal problems by moving from one employment situation to another.

   v)     Differences in perceptions of equity

It is essential that the various financial and psychological rewards employees receive from their work be equitable, both in terms of what is demanded of them, and in terms of what others are receiving for their work.  Even more important, these rewards must be perceived by the employees as being equitable. Otherwise, the satisfaction and benefits that might be derived from effective job design and employee‑job matching may be reduced substantially.

  vi)                  Differences in occupational prestige

Employees may derive satisfaction from the prestige of their occupation and/or reputation of the organization in which they work. It is a source of satisfaction for employees to have friends and acquaintances know that they are part of a prestigious organization and making a contribution to it, even if only in a very small way. In fact one study indicated that occupational prestige contributes more to job satisfaction than does work autonomy, authority or income.

 vii)      Satisfaction through job enrichment

Job enrichment essentially is an extension of job enlargement (i.e., giving employees a greater variety of duties to perform), which may involve increasing autonomy and responsibility of employees, or including them to a greater extent in the decision‑making process. It provides employees with the opportunity to make greater use of their knowledge and skill by becoming more involved in planning, directing and controlling the work of their jobs. Job enrichment may include delegating to a work group greater authority for self‑management. It also may include improving communications to the extent that employees are made more aware of the fact that good performance will be recognized and will contribute toward the attainment of both personal and organizational goals. The basic contribution of job enrichment, therefore, is to make their work more meaningful and to provide employees with a greater sense of responsibility and better knowledge of the results of their endeavours.

2.   Formalizing organizational structure

Organization charts are the most common method used to formalize the structure of an organization.

a)   Organization chart

An organization chart is merely a graphic representation, or blue print, of all positions in a facility and departments of that facility and how they are connected. The position with the greatest authority is located at the top.  Solid lines are used to show line relationships, that is, those positions that have a direct responsibility in accomplishing the objectives of the organization, and indicate to whom each position reports thus clarifying the position’s authority and responsibility.  Dotted lines are used to show staff relationships, that is, those positions that are of an advisory nature.

No organization chart can totally reflect the facility’s structure.  The informal relationships between employees are generally omitted.

The organization chart should be updated every time there is a change in reporting relationships.  It is therefore important to date the organization chart.

A flow chart of the work in the health record department should also be prepared, and kept updated, to identify any problem areas.

b)   Organizational manuals

The departmental manager must set goals and objectives and provide scope and direction for his/her staff.  S/he must be a good leader, a good listener and a good planner.  The department must have a clear set of policies and written procedures.

Policies provide guidelines for decision-making; they define the area in which decisions are made but do not provide the manager with the decision.  Thus, the policies aid the manager in the decision making process.  It is important that policies be followed consistently, especially as they apply to personnel issues.  Lack of consistency may result in staff issues relating to fairness and equity.

c)   Procedures

A procedure is a structured, action-oriented list of sequential steps involved in carrying out a specific job or solving a problem (LaTour and Eichenwald, 2002).  It is a series of related steps designed to accomplish a specific task.  The health information management/health record professional is responsible for planning the department’s procedures and providing for a standardization of work tasks within the health record department. Each procedure must be carefully planned to help with productivity and reduce time and effort.

When establishing procedures the following points should be considered:

  • display the title and revision date

 

  • determine all the steps required for a procedure and use only the minimum needed to carry out the procedure

 

  • determine the best sequence for the performance of each step in the procedure

 

  • number each step, and begin each activity with an action verb

 

  • review procedures which might be affected by changes in other procedures

 

  • test a procedure before putting it into everyday use

 

  • evaluate the procedure after it has been used for several weeks.

 

If applicable, include samples of completed forms.  All procedures should be written and updated regularly to eliminate redundancy. 

3.   Organizational change and development

Change is an integral part of the work of any organization and health information management/health record professionals must be prepared for change within the facility and within the functioning of their own department. They must learn to deal positively with resistance to change. This would require the following:

  • continued in‑service education programs for staff

 

  • open lines of communication between staff and the health information management/health record professional

 

  • participation and involvement of staff in planned change

 

  • facilitations and support of staff during and after a planned change

 

  • negotiation and agreement with staff relating to changed work conditions and other issues

 

  • co‑operative work performance both from management and staff

 

  • feedback to staff on effective changes and appreciation of work undertaken by staff in the implementation of the change.

 

4.   Developing human resources

Staffing and human resource management is the process of assuring that competent workers are selected, trained and rewarded for their assistance in helping the facility and department achieve their objectives. Being effective in this area also includes providing a work climate in which employees can experience satisfaction and development.

Developing human resources, therefore, includes:

  • employment planning

 

  • advertising for new staff

 

  • recruiting quality applicants

 

  • selecting the best person for the job

 

  • orientating the new staff member to the facility and the department

 

  • training and developing new employees

 

  • appraising work performance on a regular basis (at least once a year)

 

  • compensating the competent worker with the right remuneration.

 

C.        DIRECTING

Directing, also referred to as leadership, and interpersonal influence is the process of inducing individuals (peers, superiors, sub‑ordinates) or groups to assist willingly and harmoniously in accomplishing the objectives of the facility and the department.

D.        CONTROLLING

This is the process of ensuring the efficient use of resources and achieving the objectives of the facility.  It involves:

  • establishing standards of performance of staff and self

 

  • comparing current performance against established standards to determine the departments progress toward the set objectives

 

  • actively working to reinforce a high quality of services by the department and correcting any shortcomings or problems as they occur.

 

E.        PROBLEM SOLVING

This is an extremely important function of a manager, particularly within a very busy health record department.

1.   Problems must be dealt with efficiently and effectively and should not be handled lightly or ignored.

2.   Steps in the problem solving process include:

  • Defining the problems (What is wrong?)

 

  • Identifying causes and underlying relationships of the problem.  (What caused the problem?)

 

  • Analysing the evidence relating to the cause of the problem.  This can become quite detailed and difficult.

 

  • Developing alternative courses of action and identifying consequences of the action. (What can be done to solve the problem?) You may come up with a number of alternatives.

 

  • Selecting the ‘best’ alternative and developing defined steps to implement the selected alternative.

 

  • Evaluating the outcome of the implemented solution.  (Has it been effective?  Is the problem resolved?)

 

SUMMARY:

Management is a complex issue.  We would all like to be considered a good manager.  If you remember the basic management principles outlined in this unit, and supplement your knowledge by further reading, you will develop good managerial skills.  Remember, however, no one is perfect and no matter how hard we try we all make mistakes at some time. We are often not as effective or efficient as we would wish to be.  We are, however, capable of learning from our mistakes and by continually learning, become more effective and efficient in our jobs.

To be a good manager, therefore, the health information management/health record professional should set objectives for the services of his department and continually work towards:

  • improving work performance of staff
  • improving work satisfaction
  • planning for change and implementing change
  • improving the layout of the department
  • organizing effective and efficient work flow
  • setting standards of work performance for staff
  • directing the services of the department to see that health records are readily available for patient care at all times

 

This unit briefly covers some important areas of management and as discussed at the beginning of these learning packages the material presented is not definitive.  There is still a lot to learn and we strongly advise that you continue to do so by reading, listening and participating in as many educational activities as possible.

REVIEW QUESTIONS:

1.  Why is planning and organizing so important for a health information management/health record professional?

2.  Draw an organization chart of a health facility and of a health record department.

3.  Draw a flow chart to indicate the flow of activities in a health record department.

4.  Write a job description for your position.

5.  Identify a problem and work through the steps of problem solving.

REFERENCES:

1.         Huffman, Edna K. Health Information Management.  10th ed. Berwyn, IL: Physicians Record Company, 1994.

2.         Johns, Merida, ed.  Health Information Management Technology: An Applied Approach.  Chicago: AHIMA, 2002. (Note:  A good source for a health record director’s job description can be found in this book in Appendix A page 816 and an organizational chart in Figure 20.1 page 766.)

3.         LaTour, Kathleen, Eichenwald, Shirley, ed.  Health Information Management:  Concepts, Principles and Practice.  Chicago: AHIMA, 2002. (Note:  A good source for organizational charts can be found in this book in Figure 231 page 560 and a sample flow chart Figure 22.1 page 528.)

4.         Skurka, Margaret.  Health Information Management:  Principles and Organization for Health Information Services.  San Francisco, CA:  Jossey- Bass, 2003.

 selesai@hak cipta Dr Iwan Suwandy,MHA 2010

Modul Pelatihan Praktisi rekam Medis : Planning Health Record Departement

Education Module for Health Record Practice

Based On IHFRO modul

UNIT 5  ‑ PLANNING A HEALTH RECORD DEPARTMENT

Health information management/health record professionals are acutely aware of the need for proper facilities for the efficient and effective operation of the health record department.  In fact, it has been recognized for some time that architects, health facility planners, administrators and heads of departments, should plan for construction of specialty areas together, as a team.  Although in many instances this has in fact happened, for a number of departments there has been little participation by health information management/health record professionals.  The reasons for non‑participation are varied and range from the health information management/health record professionals not being consulted or involved because the planning authorities do not realize their ability in this area, or the health information management/health record professionals has not been interested or has felt incapable of involvement in such a daunting task.

OBJECTIVES:

At the conclusion of this unit participants should be able to:

1.      explain the functions of a health record department for planning purposes

2.      identify the most suitable place for a health record department

3.      calculate space required for defined functions, staff and health record storage

4.      communicate effectively with architects and hospital administration to ensure departmental needs are recognized.

INTRODUCTION:

The hospital administration is responsible for seeing that the health record department of their institution have adequate facilities and equipment for the efficient day‑to‑day operation of the service.  The criteria to meet this standard includes:

1.      the health record department/office should be located in such a place as to facilitate the rapid retrieval and distribution of health records

2.      the Office and work space should be sufficient for health record staff to perform their duties and for other authorized personnel to work with health records, including records on microfilm or computer

3.      there should be sufficient storage space for health records to allow for future storage needs. This includes:

a)   an active storage area with sufficient space to include all health records currently in use by hospital staff, and

 

b)   available space to provide for both active and inactive health records being stored under statutory guidelines

4.      areas for active and inactive health record storage should be sufficiently secure to protect records against loss, damage, or use by unauthorized persons (ACHS, 1992).

The planning of a health record department, whether for a new hospital or relocation within an existing hospital, should develop from the interaction of three people: the health information management/health record professional, the facility’s planning co‑ordinator and the architect.  The health information management/health record professional contributes ideas especially on the detailed functions of the proposed department; the planning co‑ordinator has an understanding of the total requirements within the facility and co‑ordinates all departmental planning and the architect is responsible for defining, both verbally and graphically the building or complex to meet   specified objectives.

To design a department that will offer both efficient and effective services, the planning team must clearly define the functions of the department and the inter‑relationships of the proposed department with other departments/areas of the facility. For example, will the health record department be responsible for transporting health records, for ordering and storing health record forms, or will these functions be the responsibility of another department. This involves looking at procedures to be performed, staff requirements for the performance of these procedures, the flow of work planned for the department and the hours of services offered. This information should be stated in clear, logical writing, with sufficient detail for an architect to understand what is required. 

The six phases determined by the architects which they believe should be observed when designing a new hospital department are as follows:

A.      Definition phase, is the definition of the precise need the design of the department is to meet

B.      Brief phase, is a detailed nomination of the estimated facilities to meet the defined need

C.      Department phase, the integration of one specific area or department into the greater complex of the total facility.  In this phase the key people in the facility along with the architect and planning co‑ordinator establish ideal working relationships with other departments

D.      Total facility phase, which looks at wants, as compared to needs, compared to available resources.  A total hospital proposal is prepared to enable the selection of the most viable scheme for the department

 

E.      Process phase ‑ at this stage attention is focused on the actual function of the individual departments.  This means that each proposed procedure to be performed in a department is thoroughly analysed and assessed.  Diagrams illustrating the various processes and procedures, most of which were completed in the definition phase, are extremely useful as graphic expressions of physical requirements and associated services.  It is at this phase that attention must be paid to the welfare, comfort and health of workers in the proposed requirements for the department.

F.      Department design phase is the stage where the architect prepares final proposals to enable an optimum design to be prepared and selected.  Detailed drawings of each department are prepared, including all special requirements. There must be a systematic means of assessing and comparing the various schemes to enable the planning team to reach a final decision.

In this Unit we will concentrate on the first two phases since these require the greatest participation by the health information management/health record professional and also have the greatest applicability in improving the layout of an existing department.

A.    DEFINITION PHASE

When preparing for this first phase in the planning of a health record department, there are five major points to be considered.  These are:

1.      location of the department in regard to services and inter‑relationship of service areas

2.      space requirements for records, for personnel and for equipment

3.      functional design and logical placement of key work areas

4.      system of communication within the health record department and between the department and other areas of the facility

5.       systems to be used to transport health records within the department and to other departments and wards.

1.      Location

When determining location consideration must be given to the need for the department to be centrally located where it will provide:

  • prompt service for all patients ‑ inpatients, outpatients and emergency

 

  • ready accessibility for medical officers and other users, and

 

  • easy availability for administrative use.

 

 

That is it should be:

  • adjacent to the Admission Office, the Emergency Department (ED), the Outpatient Department (OPD)

 

  • close to medical staff office, entrance, or lounge

 

  • close to the administrative and business offices

 

  • close to other service departments, e.g. x‑ray, pathology, etc.

 

While it is desirable to have the health record department centrally located, it is accepted that this is not always possible.  If this is the case and the department cannot be logistically situated near all these areas, the first three should have top priority and, in most situations, the proximity to the outpatient and accident and emergency departments would have the highest priority, as these two areas usually have the greatest utilization of records with speed of access often essential.

2.      Space

Regardless of the type of facility, when planning for space requirements for records, personnel and equipment, the health information manager/health record administrator must consider the following:

  • population of the district served by the hospital
  • hospital services proposed
  • number and type of beds
  • current and projected number of discharges/deaths and outpatient and emergency registrations and visits
  • major functions to be performed in the department
  • number of personnel required to perform proposed functions
  • equipment most suitable for the work to be done
  • extent of computerization anticipated
  • type of filing system to be used
  • the numbering system
  • whether the record services are to be centralized or decentralized
  • whether emergency/casualty records are to be included in the main record
  • number of years of active storage
  • length of time original records are to be retained and whether inactive records will be selectively purged or microfilmed,
  • type of secondary storage required
  • special services to be offered by the department.

 

a)   Space for records

Before calculating file space required, decide how many years of health records should be kept in active filing and estimate the number of records generated per year.

The retention schedules for health records recommended by the local health authority (or national retention schedules where appropriate) should be considered when determining record activity.  These retention schedules usually take into consideration:

  • the statute of limitations for legal protection, and
  • state or national regulations

 

Retention for longer periods than determined by health authorities or national retention schedules, however, could be influenced by:

  • available storage space, and
  • the clinical and/or research value of the records.

 

Once the proposed numbers of records and the activity rate have been determined the estimated number of medical records over the number of years of active filing can be calculated.  The steps required are as follows:

  1. Given the number of annual discharges/deaths and OPD registrations (+ ED/A&E new patients if to be filed in main health record) and the number of years required for active storage, e.g. 7 years, you can determine the number of records to be generated over a 7 year period, e.g.

 

Annual OPD registrations                       3000

Annual discharges/deaths                   2,3000

(No ED/A&E)                                                _____

26,000 records per year

26,000 per year for 7 years = 26,000 x 7 = 182,000 health records in 7 years

It should be noted that these figures overestimate the number of actual records, as discharges will include readmissions. However, this is a better figure to use as it allows space for the expansion of the file with each re‑admission plus the workspace needed for efficient filing and retrieval.

  1. The next step is to determine the average size of each health record e.g. one record = 2cms of linear shelf space

 

  1. Determine how many records to 1 meter of linear shelf space,

i.e.  100 = 50 records to 1 meter

  1. The total filing space required, therefore, for these health records can be calculated as follows:

 

annual discharges/deaths + OPD reg  x storage years required

records per meter

e.g.  using the above example:

23,000 + 3,000    x    7          =          182,000  =     3,640

                        50                                               50

Therefore for 182,000 health records, 3,640 meters of shelving is required.

  • As well as determining what is adequate to meet the needs of the present, the needs of the future, i.e. in 10 or even 20 years, should also be considered.  This can be achieved by an estimate, for example a 10% increase in discharges/deaths and OPD registrations over the next 10 years.  This will change the filing space required to:

 

10% of 3640 = 3640 + 364 = 4004 meters required.

  • To calculate the total number of units required:

 

determine the number of meters of storage per unit,

e.g. each unit      = 6 shelves high x 2 meters wide

= 12 meters of storage per unit

4004  = 333.66 or 334 units of 6 shelves

       12

  • For terminal digit filing, to calculate the number of meters of shelving required for each primary digit the following formula should be used:

 

meters of shelving required

number of sections in file

4004

100     = 40 meters per primary section

Each terminal digit will therefore occupy 20 full shelves.  Should, however, the calculations show that each terminal digit will occupy only a portion of a shelf one might want to adjust the number of shelving units to be acquired (or reduce the space allotted to each terminal digit).

b)  Secondary storage

If a secondary storage area is considered it should ideally be located within the department, or immediately adjacent to it, or directly underneath with its own stairway. There are a number of advantages for keeping non‑active health records readily accessible and available, two of which are that:

  • it is time saving for staff, and
  • offers easy access for refiling.

 

If storage space is a problem and microfilming of inactive records is being considered a special room for microfilming will need to be planned.

To calculate the space required for secondary storage, divide the total number of records to be stored by the number of records to 1 metre, i.e. 150,000 inactive records to be stored and there are 50 records to 1 metre divide 150,000 by 50. Health records, however, are generally filed in serial order in secondary storage allowing for shelves to be packed to capacity, and this could allow for 80 records to 1 meter.  The reason you can get more records/meters is (i) no need to allow for growth of individual record and (ii) no need for working space since there will be little movement.  The calculation would then be:

150,000  = 1875 meters of shelving required for secondary storage

   80

c)  Master Patient Index (MPI)

Consideration must be given to the space the patients’ master index will occupy. When all or part of the MPI is on cards, the space requirements can be considerable. The steps to be followed in calculating the space needed to file the index cards and guides are the same as those for the health record files.

d)  Planning space for personnel and equipment

When planning for personnel and equipment requirements, consideration must be given to the functions to be performed within the department and the services offered by the department to other areas.

The number of staff determines the floor space; desks, files and other equipment necessary, and ample room must be provided for each employee.  Huffman (1994) recommends that the minimum space allocated for each office worker should be 5.57m2 (16 sq ft), although this estimation may vary, it is still a good guideline.

It is generally accepted that the staff of a medical record department are responsible for the initiation, completion and maintenance of a medical record for every person attending the facility as an inpatient, outpatient or accident/emergency patient.  The major functions of a health record department usually include:

  • the initiation of health record documentation and the design and control of all record forms

 

  • initiation and maintenance of a unique patient identification system and master patient index (MPI)

 

  • preparation of new outpatient and emergency department health records and the update of records of returning patients

 

  • assembly, completion and control of incomplete records for discharged/deceased inpatients

 

  • classification of diseases and the collection of morbidity/ mortality statistics for all hospital discharges/deaths

 

  • collection of health facility statistics relating to discharges/deaths, length of stay, occupancy rates for administrative and health department use

 

  • filing and retrieval of all inpatient and outpatient health records with an inbuilt record control system

 

  • transcription services covering discharge summaries, operation reports, outpatient letters and medico‑legal correspondence (using word processing facilities)

 

  • services to medical and other health professionals for the retrieval of health records for research and teaching purposes

 

  • in some situations the functions of the health record services includes patient reception and processing in the outpatient department, admission office and accident and emergency centres.

 

3. Staff required

Once the functions of the department have been determined, consideration should be given to the number of staff required. Hospital policy regarding the number of hours in the work week and the hours of service for the health record department (24 hours a day, seven days a week versus some other schedule) will be a major factor in this determination along with the functions to be performed, the number of annual discharges/deaths, OPD and ED/A&E visits (if ED/A&E reports are incorporated in the unit record), and research undertaken by medical staff.

(a)  Forecasting:

Once the health information management/health record professional has:

  • determined the predicted number of discharges/deaths, and OP/ED visits, and predicted specialised work, e.g. research, quality assurance, etc.

 

  • determined the functions of the department and services to other departments

 

  • determined the hours of service eg 24 hours x 7 days per week or less

 

  • defined each function and determined the tasks to be performed

 

  • defined how each task is to be divided into manageable work units or jobs

 

  • analyzed each job to determine the content, skills, knowledge and responsibilities, and

 

  • prepared a job description and job specification for each job,

 

The next step is to forecast the number and type of staff required to perform each job. That is, the health information management/health record professional needs to be able to predict the number of direct employee hours required to cover the jobs outlined in each job description. There are a number of forecasting techniques used to cope with the problems involved with human resource forecasting. For our purposes, traditional statistical projection could be used by using the correlation of staff to patient discharges/deaths and attendances. The time to process one health record of a discharged patient can be estimated as suggested in the following hypothetical example:

  • Collection of records from designated collection area             3 minutes
  • Pulling of work cards from the hospital box                               1    “
  • Assembling record into correct order                                            3    ”   
  • Checking record for deficiencies and retrieval

                        of loose sheets                                                                                 3    ”

  • In case of re‑admission, retrieval of old records or

                        if new patient, preparation of new folder                                     3    ”

  • Assigning record to appropriate doctors for completion            2    “
  • Filing record in incomplete file area                                             2    “
  • Filing work card in work box                                                          1    “
  • Filing outguide on file                                                                       “

            20 minutes

By the above calculations, it is estimated that the discharge procedure for each record takes 20 minutes.  If there were 70 discharges/deaths per day for seven days, the total time to process these records would be:

70 x 20 x 7 = 9800 minutes or 163.3 hours

If each clerk worked 7.5 hours per day for five days, the number of staff required for this process would be:

163.3  = 4.35

37.5

That is, 4.5 full-time equivalent staff members would be required to complete the discharge procedure in a hospital with approximately 25,480 annual discharges/deaths.

A similar procedure could be undertaken for each job within the department using the prepared job descriptions.

Alternatively, another method would be to use a work distribution chart as illustrated below.  By this method, previous information relating to departmental functions and jobs can be used to estimate the time each job takes.  That is, by listing the work activities performed and the estimated time it takes to perform them, we can estimate the number of staff required.

  Hours                                               Hours

Activity                         per week      Activity                       per week

Record assembly           106           Retrieval of

Record analysis               50              records for Clinics               76

Admissions                       57            Transcription                         114

Filing recent discharges   18         Release of Information         40                 

Telephone/enquiries        16          Filing                                        38

Statistics                            19            Research                                 36                    

Coding                              13                                                304

Indexing                            25           

                                              304                                                          

Based on a 37.5 hour week, calculate staff as follows:

608   = 16.2

37.5

The health information management/health record professional could then indicate the actual staff required for each job, e.g.

Record retrieval & filing                                 3

Transcription                                                   3

Release of Information                                   2

Separations & Enquiries                                5

Coding & Indexing                                          1

Admissions & Statistics                                  2

                  16

Relief staff based on estimated absences such as recreation leave, sick leave, etc. should also be determined, as should supervisory and professional staff requirements.

e)  Health information management/health record professional’s office space

Since privacy is desirable for the health information management/health record professional (for talks with personnel, doctors, lawyers, administrators); a private office may be necessary.  However, in smaller hospitals the director may prefer to be with the staff in the main department area.

f)   Other special areas

  • A section of the health record department should be provided away from the flow of traffic for the medical staff so that they can complete their records or review records for research in reasonable quiet and comfort.

 

  • A special area is often required for transcription. Medical transcription should be confined to one area because of noise ‑ sound proof booths or partitions help reduce the noise of computer equipment and printers.

 

4.      Equipment

The number of staff and the functions of the department will determine the equipment required.

As well as planning space requirements for records and personnel, consideration must also be given to the allocation of sufficient space for the equipment required to cover the defined functions of the department.

The major areas for consideration are:

a)   Filing

Type of shelving to be used is important and it is generally accepted that open shelving is the most practical. It utilizes less floor space than other forms of filing equipment, allows for faster filing and retrieval and lends itself to any type of filing system used. Once the amount of shelving required is calculated, the amount of floor space required for the shelving can also be calculated using the width and length measurements of each bay of shelving.

The space should also be allocated for aisles and it is generally accepted that main aisles should be 150‑155 cms wide and secondary aisles 90‑95 cms wide.

b)   Computer facilities

The level of initial computerization would have been defined in the determination of functions and job analysis and sufficient space must be planned for terminals and ergonomically sound work areas.  If the entire department is not air conditioned, provision should be made to protect the computers from excessive heat and dust.

c)   Dictation/transcription

Appropriate space for dictation and transcription services needs to be carefully planned to allow for ergonomically sound facilities and work areas.  The use of a dictating service with a central receiving unit encourages doctors to dictate reports and discharge summaries promptly. Computers for word processing are now widely used in health care facilities and appropriate space must be allocated to ensure efficiency and also the health and well-being of the staff.

d)   General

The number and therefore, space requirements, of desks, chairs, typewriters, telephones, filing cabinets and other office equipment will be based on the jobs to be performed and the number of personnel required. Staff working different shifts can occupy the same work area.

Department personnel should have a place to store their belongings (handbags, umbrellas, coats, etc) safely.  A tea or lunchroom should be available for staff to take their break so that they do not eat and drink at their desk.  Convenient access to hand-washing and toilet facilities is needed.

e)   Special space

Space requirements for a photocopier, storage cabinet (for supplies and folders, etc), bookshelves, and any other special equipment should also be defined at this stage.  If microfilming is planned, space for the necessary equipment, e.g. microfilm camera, reader‑printer, jacket‑filler, filing cabinets and work area must be considered in the planning stage.

The predetermined departmental functions, job descriptions and number of proposed staff, however, will enable the health information management/health record professional to determine the equipment and furniture needed and the approximate space required for the work area.

5. Functional design and logistical placement of key work areas

When considering functional design and layout, a key consideration is workflow.  At this stage of definition, the health information management/health record professional should prepare work flow diagrams   to indicate the workflow from procedure to procedure or desk to desk.  Keeping in mind that:

  • desks should be arranged so that paper moves in a straight line and only a short distance at a time

 

  • desks should be next to each other for procedures performed in sequential steps

 

  • amount of floor space required will depend largely on record activity and whether or not data processing or microfilm programs are established, and

 

  • equipment should be chosen for reasons of both efficiency and appropriateness.

 

The use of a layout diagram or flowchart, sometimes called or movement diagram (LaTour 2002), which is a diagram of the flow of work through the layout, can assist with determining that furniture and equipment are placed effectively.

When preparing a layout for the architect, the health information management/health record professional should be able to use appropriate terminology and blueprint symbols to illustrate the essential features such as columns, lifts, doors, windows, furniture and equipment, etc.  This will give everyone including the health information management/health record professional, a visual image of the proposed department. 

6.      System of communication

During the definition stage, consideration must be given to the communication system to be used within the department and between the health record department (HRD) and other departments or areas.

Most health record departments require numerous telephones placed at strategic points within the department. In addition, some hospitals may use intercom systems between the ED/A&E and the HRD, or the OPD and the HRD.

If computer terminals are to be used, both as communication devices between the HRD and other areas and for the input and output of data, the cabling for such devices is an important part of the planning process.   If the entire department is not air conditioned, consideration must be given to air conditioning the area where the terminals are located not only to prevent them from overheating but also to protect them from excessive dust.

7. Transport

Consideration must be given to how the health records are to be transported both within the HRD and to other areas. If carts are to be used within the department they have to be able to be pushed freely between desks and files. If a dumb waiter or pneumatic tube or other automated device is to be used, special space provision in the appropriate place must be made.  Some hospitals use motorized trolleys, which need to be stored in the HRD when not in use. Provision for all these needs must be considered in the definition phase of planning.

8. Layout

In determining the physical layout the following points should also be considered (LaTour, 2002 and Huffman, 1994).

  • it is important that full use be made of available space. Desks and files must be arranged to provide maximum efficiency, light and air

 

  • to eliminate the hazard of electrical cords, attention should be given to the most convenient placing of electrical outlets for the use of any electrical equipment

 

  • temperature control and circulation of air, i.e. adequate ventilation, fans, windows

 

  • adequate lighting ‑ i.e. well positioned lighting (experts should be consulted as to levels required and correct placement). Workers should not face glaring lights

 

  • use of colour ‑ walls, floors, furniture and equipment (light colours for walls ‑ bright for accents and trims)

 

  • to keep traffic flow in the medical record department to a minimum, it may be desirable in many hospitals to have a reception and/or waiting area where an employee may attend to requests

 

  • employees handling enquiries should be placed near the main entrance

 

  • equipment should be near users and the doors wide enough for record carts

 

  • desks should face the same direction with 1 to 1 ½  meters between desks

 

  • supervisors should be at the back of the people she/he is supervising ‑ should be able to see all employees without leaving desk

 

  • two desks placed side by side in the same direction is a compact arrangement

 

  • it is best to place the file space to the back of the department ‑ it should not be placed near the main entrance (for safe keeping)

 

  • sufficient space for workers to stretch and move around.

 

B.    THE BRIEF PHASE

At the completion of the definition phase the health information management/health record professional should be ready to prepare a brief for the architects, which will include the proposed functions and services of the department, the preferred location, and the capacity with regard to space, staff and equipment, relationship to other departments, and any other design features to be considered. Requirements may be illustrated by drawing a plan.

The brief should include work flow diagrams, and a proposed layout with specific reference to ergonomic consideration in all aspects of the design. If the health information management/health record professional does not feel confident in making determinations on ergonomic issues an expert in this area should be consulted.

SUMMARY

Effective planning of a health record department for a new facility or in an existing one is an important responsibility, which should be readily accepted by the health information management/health record professional. As discussed previously, the planning process should begin with clarification of the functions to be performed and services to be offered. The health information management/health record professional is the best person to undertake this important step and should be prepared to do so.

REFERENCES

1.         Davis, Nadinia, and LaCour, Melissa.  Introduction to Health Information Technology.  Philadelphia, PA:  W.B. Saunders, 2002.

2.         Huffman, Edna K. Health Information Management.  10th ed. Berwyn, IL: Physicians Record Company, 1994.

3.         Johns, Merida, ed.  Health Information Management Technology: An Applied Approach.  Chicago: AHIMA, 2002.

4.        LaTour, Kathleen M., and Eichenwald, Shirley.  Health Information Management:  Concepts, Principles and Practice.  Chicago:  AHIMA, 2002. (A good source for a flowchart for loose chart filing can be found in this book in Figure 22.1 page 528.  Also a movement diagram in Figure 22.2 page 530.)

5.         Skurka, Margaret.  Health Information Management:  Principles and Organization for Health Information Services.  San Francisco, CA:  Jossey- Bass, 2003.

 selesai@hak cipta dr Iwan Suwandy 2010

Modul Pelatihan Praktisi Rekam Medis unit 4 c “The key of Question Answer”

Appendix 2 – Answer Key to Appendix 1

Education Module 4 – Healthcare Statistics

 based on IFHRO modul

EXERCISE 1 – Patient Care Unit CENSUS

1.    Using the information from the left of the page, complete the daily census for patient unit A.

UNIT A                                                                        DAILY CENSUS FOR DATE 6.3.06

 

John Smith adm. from                                    a.         No. on unit last report              40

O.P.D. (Dr. Richard)

Adam James adm. Dr. Maurice                                 No. admitted                             5

Stanley Paul adm. G.P.                                              No. transfers in                         1

Anthony Greech trans.                                   b.         Total                                          6

from other hospital

Patrick Sterling trans.                                                 No. discharges                          5

from Med. (Ward B)

Gordon Thompson died 10.30 a.m.                            No. Deaths                                2

Wayne Johnson emerg. adm.                                    No. transfers out                       1

Brett Arnold disch. O.P.D.                              c.         Total                              8

Michael Stephens disch. G.P.           

Adam Carpenter trans.                                               Today’s census

to Psych. (Ward D)                                                     a + b ‑ c           =  40 + 6 – 8 = 38

John Trip trans. to

other hospital

Wayne Johnson died 4.30 p.m.

John Smith disch. O.P.D.

Thomas Adams disch. O.P.D.

2.    Number of patient days for patient unit A on 6-3-06:   40

38 + 2 patients admitted and discharged on 6-3-06  =  40

 

                                    EXERCISE 2 ‑ HOSPITAL CENSUS REPORT

Date:        6-3-06    

Complete the data for Unit A from Exercise 1.

Complete the Hospital Census report.

What checks for accuracy can you use?

 Unit  Prev.

Day

Census

 Admi-

ssions

 Transfers

In

 Discharges  Transfers

Out

 Today’s

Census

 Alive  Deaths
 A   40  5  1 from B  5  2  1 to D  38
 B   35   4  2 from C      1 to A  41
 C   23   8     4     2 to B  25
 D   28   3  1 from A   2   1    28
 E   30   6     3      33
 TOTAL  156  26  4  14  3  4     165

 

Accuracy checks:

1.    Total transfers in equal total transfers out

2.    Today’s hospital census is result of adding total admissions and transfers in to previous day census, and subtracting from this the total discharges and transfers out.

156 + 26 + 4 – 14 – 3 – 4 = 165

 

                                             EXERCISE 3 ‑ HOSPITAL CENSUS

Complete today’s hospital census report

HOSPITAL CENSUS REPORT 

 

August 27, 2006.

 Unit  Prev.

Day

Census

 Admi-

ssions

 Transfers

In

  Discharges  Transfers

Out

 Today’s

Census

 Discharges  Deaths
 A   40   3     2    2 to B   39
 B   26     2 from A   4  1  1 to D   22
 C   31   8  2 from D   5  1     35
 D   45     1 from B  10    2 to C   34
 E   12   6           18
 TOTAL  154  17  5  21  2  5  148

 

 

                                                                EXERCISE 4

1.    Compute the length of stay of 10 patients who were discharged from hospital on October 6, 2006.  Their dates of admission were as follows:

(a)        September 12                     24                 (f)        September 11 ­   25

(b)        September 28                  ­­­     8                 (g)        October 5                        1

(c)        September 30                       6                  (h)       September 16    20

(d)        September 26                     10                  (i)        October 6                          1

(e)        October 4                  2                              (j)        August 13                        54 

(k) What was the average LOS?     15.1  151 divided by 10

2.    In a 200 bed hospital, the patient days for 2006 were 62,050.   The 6,495 patients who were discharged or died had a total of 61,930 days care.  Using the above figures, compute the following averages and rates, showing formulae used.

(a)        62050 divided by 365 = 170 patients

(b)        (62050 x 100) divided by (200 x 365) = 85.0%

(c)        61930 divided by 6495  =  9.54 or 9.5 days

 

EXERCISE 5

1.    A Coronary Care Unit in a large teaching hospital had a total bed count of 20 beds in 2006.  During the year the patient days for the unit were calculated at 5,260 days.  The 1,255 inpatients who were discharged from the unit during 2006 spent a total of 5,066 days there.

(a)   5260 divided by 365 =  14.41 or 14 patients

(b)   5066 divided by 1255 = 4.03 or 4.0 days

(c)   (5260 x 100) divided by (20 x 365) = 72.054 or 72.1%

2.    The following data have been collected from a 700 bed general hospital during 2006:

Patients admitted                                                          14,117

Total discharges/deaths                                                14,086

Total discharge days                                                   137,202

Total inpatient patient days                                         226,842

Total registered outpatient attendances                      192,846

From the information above, calculate the following, showing formulae:‑

(a)        137202 divided by 14086 = 9.74 or 9.7 days

(b)        226842 divided by 365 =  621.48 or 622 patients

(c)        (226842 x 100) divided by (700 x 365) =  88.78 or 88.8%

3.    In a local hospital, the average length of stay in January 2006 was 10.4 days.  The number of patient days care rendered to discharged patients in the same period was 5,460.  How many discharges were there in January?

                             5460 divided by 10.4  = 525 discharges/deaths

4.    A 460 bed general hospital assigned 215 beds for general medical service, 125 beds for general surgery including Orthopedics, the remainder, 120, were divided among the other services.  For the past 12 months (2004) the number of patient days within the three major categories were:

Pt. days                            Beds                       Bed days

A.  General medicine       59,059                         215      x 365                 78690           

B.  General surgery          43,070                         125      x 365                 45750

C.  Other services                        35,040                         120      x 365                 43920

Using the above information calculate the following for each of the three categories:

 

General Medicine                           General Surgery                  Other Services

(i)     5905900/78690= 75.1%         4307000/45750 = 94.1%       3504000/43920 = 79.8%

(ii)   59059/365 = 161.36 or 161    43070/365 = 117.67 or 118   35040/365 = 95.73 or 96

 

 

 

 

 

EXERCISE 6

A 477 bed general hospital had 15,746 patients discharged/died in 2006.  Total deaths for the year were 487.  There were 81 cases reported to the Coroner, and 351 autopsies were performed.

Total patient days were 136,995 and the total length of stay of discharged/died patients was 136,540. 

Give the formulae, and using the above information, compute the following:

1.    (487 x 100) divided by 15746 = 3.09 or 3.1%

2.    15746 divided by 477 = 33.01 or 33.0

3.    (351 x 100) divided by (487 – 81) = 86.453 or 86.5%

(The 81 Coroner’s cases were NOT autopsied at the hospital)

4.    136450 divided by 15746 = 8.67 or 8.7 days

 

EXERCISE 7

1.    The following data have been collected from a local hospital.  The average length of stay in June was 5.2 days.  The total length of stay of discharged/died patients in the same period was 2,730.  There were 18 deaths, including 2 unautopsied Coroner’s cases and 12 autopsies were performed.

a.          Number of patients discharged/died = 525

(18 x 100) divided by 525 = 3.43 or 3.4%

b.          (12 x 100) divided by (18 – 2) = 75.0% (.0 for uniformity with other indicators)

2.    The following data have been collected from a 700 bed general hospital during 2006.

Patients admitted                                                             19,957

Total discharges/deaths                                                   19,933

Patients remaining in hospital midnight

Dec.31, 2005                                                           632

Patients remaining in hospital midnight

Dec.31, 2004                                                           656

Total length of stay of discharged/died patients           218,515

Total patient days                                                         236,842

Total deaths                                                                         615

Total autopsies performed                                                   485

Coroner’s cases (unautopsied)                                              43

Number of anaesthetics administered                             6,925

Number of operations performed                                    7,700

Total registered outpatients                                           192,846

From the information above, calculate the following:

a.         236842 divided by 365 =  648.88 or 649 patients

b.         (615 x 100) divided by 19933 = 3.08 or 3.1%

c.         (700 x 365) – 236842 divided by 19933 = 0.93 or 0.9 days

d.         (485 x 100) divided by 615 =  78.86 or 78.9%

e.         (485 x 100) divided by (615 – 43) = 84.79 or 84.8%

f.          (236842 x 100) divided by (700 x 365) = 92.69 or 92.7%

g.         218515 divided by 19933 = 10.96 or 11.0 days  (.0 added for uniformity)

 

EXERCISE 8

The following information was collected from a 500 bed hospital and includes the census figures for the 30th September, 2006 and the monthly figures for the month of September, 2004.

(a)  September 30

Patients in hospital at midnight                             418

Patients discharged 30th September                     17

Patients admitted 30th September                        24

(6 patients were admitted and discharged

the same day.)

(b)  September  2004

Total number of discharges/deaths                     1088

Total deaths                                                               43

Coroner’s Cases (unautopsied)                                  4

Total number of autopsies performed                       28

Total number of anaesthetics administered            467

Total number of outpatient attendances              16203

Total patient days during September                   12332

Total length of stay of discharged/died   

patients                                                     10943

From the above figures, calculate the following:‑

1.    Census for the 30th September                           418 – 17 + 24   =  425

2.    Patient days for 30th September                         425 + 6  =  431           

3.    12332 divided by 30 =  411.06 or 411 patients

4.    (12332 x 100) divided by (500 x 30) = 82.21 or 82.2%

5.    10943 divided by 1088  =  10.06 or 10.1 days

6.    (28 x 100) divided by 43  =  65.12 or 65.1%

7.    1088 divided by 500 =  2.18 or 2.2

8.    (43 x 100) divided by 1088  = 3.95 or 4.0%

9.    (28 x 100) divided by (43 – 4)  =  71.79 or 71.8%

 

EXERCISE 9

1.    In an obstetric hospital there were 310 live births in June 2004; of this number 7 died within the early neonatal period.  The hospital also registered 8 fetal deaths for the same month.  What rates were calculated below?

a.  (8 + 7) x 100 divided by (310 + 8) = 4.72 or 4.7%                 Perinatal death rate

b.  8 x 100 divided by (310 + 8) = 2.52 or 2.5%                          Fetal death

2.    An obstetric hospital published the following figures in 2004.

Obstetrical discharges

  • delivered                                      2288
  • undelivered                                  327
  • aborted                                            39

Total infants discharged/died                         2255

Total births (live)                                                2309

Infant deaths (early neonatal)                            56

Fetal deaths                                                            36

Maternal deaths                                                          3

Using the above information, calculate the following:

a.  3 x 100 divided by (2299 + 327 + 139)  =  0.1%

b.  56 x 100 divided by 2255  =  2.48 or 2.5%

c.  36 x 100 divided by (2309 + 36)  =  1.54 or 1.5%  

d.  (36 + 56) x 100 divided by (2309 + 36) =  3.92 or 3.9%

3.    A 320 bed obstetric hospital had 10,220 obstetric separations in 2006. There were 7,016 live births; 139 fetal deaths; 523 caesarean sections were performed with a total of 6,968 deliveries for the year and 2 maternal deaths.  There were 4 infant deaths classed as early neonatal.  Using the above information, calculate the following:

a.  139 x 100 divided by (7016 + 139)  =  1.94 or 1.9%

b.  523 x 100 divided by 6968  = 7.51 or 7.5%

c.  (139 + 4) x 100 divided by (139 + 7016) = 1.99 or 2.0%

It is not reasonable to have only 4 infant deaths.  The medical record professional should investigate to be sure that infants who die minutes after birth are not being classified as fetal deaths.

 

 

 

EXERCISE 10

You have received the following medical statistics for review prior to their publication in the Annual Report of a General Hospital.  What comments do you have regarding the accuracy of the data?

Available beds (Bed complement)                                                                             430

Total admissions                                                                                                    11,285

Total discharges/deaths                                                                             11,123

Total deaths                                                                                                                521

Patients in hospital at midnight on 31 December 2003                                              344

Patients in hospital at midnight on 31 December 2004                                              371

Autopsies performed (including 2 autopsied Coroner’s Cases)                                 378

Coroner’s cases                                                                                                            44

Total patient days                                                                                                 128,954

Total length of stay of discharged/died patients                                                  126,872

Out‑patient visits                                                                                                  106,750

There is an inconsistency in the inpatient data.  If there were 344 patients in hospital at the beginning of the year and 11,285 admissions and 11,123 discharges/deaths, there would be 506  patients remaining at the end of the year which is impossible given that the hospital has 430 beds.   344 + 11285 – 11123 = 506

Average daily census                         352                  Divided by 365 rather than 366

Percentage of Occupancy                 81.9%

Turnover rate                                      25.9

Hospital death rate                              46.8%              Multiplied by 1000 rather than 100

Gross autopsy rate                             0.73%              Did not multiply by 100

Net autopsy rate                                 0.79%              Did not multiply by 100

 selesai @hak cipta Dr iwan suwandy 2010

Modul Pelatihan Praktisi Rekam Medis Unit 4 ”

Education Module for Health Record Practice

based on IFHRO  Modul

UNIT 4a – HEALTHCARE STATISTICS

 

In this unit participants are introduced to the collection of statistical data in hospitals, community health centers and primary health care areas.

The various rates and percentages generally calculated in health facilities are discussed along with the formula for their computation and definitions relating to statistical collections.

OBJECTIVES:

At the conclusion of this unit participants should be able to:

1.   state the uses of health care statistics

2.   list the type of statistical information routinely collected in hospitals on a monthly and annual basis

3.   state the formulae used for the calculation of rates and percentages used in the collection of statistical data

4.   calculate rates and percentages used in the collection of statistical data in hospitals

5.   describe the process of statistical collections in an ambulatory setting

6.   prepare appropriate statistical reports.

INTRODUCTION:

The collection of meaningful statistics is an important function of a hospital or clinic.  Health records are the primary source of data used in compiling health care statistics. The medical record department staff, therefore, may be responsible for the collection, analysis, interpretation and presentation of statistical data wherever possible.  Today, computerized systems automatically collect and calculate many of the statistics that were once previously done manually.

Statistics are only as accurate as the original sources from which they are taken.  The health information management/health record professional should see that medical records and other source documents are complete and readily available to meet the requirements for the production of useful statistics.  Health service statistics are used for:

·     comparison of present and past performance of the hospital or clinic

·     guide for planning future development of the hospital or clinic

·     appraisal of work performed by the medical, nursing and other staff

·     hospital or clinic funding if government funded

·     research

When deciding to collect statistical data, or if reviewing existing collection systems, the hospital administrator and health information management/health record professional should ask:

 

  • Why are the data being compiled?

 

  • What use is being made, or will be made, of the information?

 

Before proceeding, we should become familiar with some definitions relating to terms used in statistical collections.

A.  DEFINITIONS

Definitions used for the collection of statistical data on hospital utilization vary from country to country.  To enable you to recognize the terms used in this Unit, the following is a list of definitions used in some countries.  If your country has a different definition for an item, or if the item is known by a different term, change the one in this Unit to the one used by your hospital/country.

1.   Admission

The formal process whereby a person is accepted by a hospital for the purpose of hospital treatment as an inpatient. If an inpatient is formally discharged from the hospital and then returns for further treatment, the admission process is repeated and a second admission is recorded in the statistics.

Live births in the hospital are considered inpatient admissions, but are always recorded separately as newborn admissions whether or not they require, during their continuous stay in the hospital since birth, special medical care in the nursery or in another clinical service of the hospital (for example, neonatal intensive care unit).  A newborn admission is deemed to occur at the time of birth in the hospital.

Typically, a patient should be admitted as an inpatient if treatment and/or care is provided by hospital staff over a period of 24 hours.

2.   Visit (also called Attendance)

A visit is a single encounter with a healthcare professional that includes all of the services supplied during the encounter.  (Horton)  This term is usually used to refer to non-inpatient services, such as outpatient.  An outpatient is one who receives ambulatory care services in a hospital based clinic or department.  A visit occurs each time an outpatient attends a hospital, nursing home or community health center and receives one or more occasions of service.

 

3.   Bed count (also called available beds or bed complement)

The number of beds (both occupied and unoccupied), set-up and staffed in an inpatient area of a hospital, which are immediately available to be used by inpatients.  In statistical returns the number of beds should always be shown as a whole number.

Bassinets used by normal newborns are counted and reported separately from other hospital beds.  Recovery room beds and labor beds are not counted as hospital beds if patients who occupy them for brief periods are assigned to another bed in the hospital.

4.   Bed count day

A unit of measure denoting the presence of an inpatient bed (occupied or unoccupied) set-up and staffed for use in one 24-hour period.

5.   Census

A count of inpatients at a given time.  The census is always taken in a hospital at the same time each day, usually midnight. The census provides the number of inpatients at census taking time

      6.   Daily census (daily inpatient census)

The daily census is the number of patients present at census taking time, plus any patients who were admitted after the previous census-taking time and discharged before the next census-taking time.

 

7.   Delivery

The act of giving birth to either a living child or a dead fetus. A pregnant woman who delivers may have multiple births.  For example, a woman who gives birth to twins will have one delivery but two births.

7.   Discharge (Separation)

The formal process whereby an inpatient leaves the hospital at the end of an episode of care.

The number of discharges includes discharges to home, transfers to other hospitals, nursing homes or other institutions, and deaths of persons who were inpatients at the time of death.

     8.    Encounter

The direct contact between a patient and a physician or other licensed independent practitioner, to order or furnish healthcare services for the diagnosis or treatment of a patient. (Horton)

      9.   Fetal death

 

“Fetal death is death prior to the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy; the death is indicated by the fact that after such separation the fetus does not breathe or show any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscles.”

WHO ICD 10: Vol.1, p. 1235-1236

 10.      Health facility

A health facility refers to any of the following:

  • State, public, general or country hospitals
  • Private hospitals
  • Psychiatric hospitals
  • Hospices
  • Nursing homes
  • Community health centers
  • Ambulatory care centers
  • Primary health care centers

 

  11.     Hospital patient

An outpatient or an inpatient to whom a hospital provides comprehensive care, including all necessary medical, nursing and diagnostic services and, if they are available at the hospital, dental and allied health services, by means of its own staff or by other agreed arrangements.

  12.     Inpatient

       A person who occupies a bed in a hospital for the purpose of hospital treatment.  

Where a patient is admitted on the expectation that he or she will remain overnight, but the patient dies or is discharged before the midnight census, the patient should still be regarded as an inpatient, whether or not a hospital bed is occupied or treatment is provided.  For example, the patient may die in the operating room or the recovery room, or may be discharged because surgery cannot be performed for medical or administrative reasons.

Patients who are held for observation in the Emergency Department or other observation areas, pending a decision whether to admit or not to admit to an inpatient bed should NOT be regarded as inpatients.  However, if a decision is taken to admit such a patient, the time of admission should be regarded as the arrival time at the Emergency Department or observation area.

A hospital newborn inpatient is an infant born in the hospital at the beginning of the current inpatient admission.  These infants are may be classified as normal newborns, or as those requiring special care because of prematurity, congenital malformations, etc., and are admitted to the neonatal intensive care unit (NICU).   Well newborns staying in the regular nursery are listed separately from those in the NICU.  Some countries include the special care newborns with regular inpatients; others group them with the well newborns.  In both instances the special care newborns should be listed separately.

Policies also vary from country to country regarding certain short-stay cases.  In some countries, for example, the following are classified as inpatients (patients may have to meet minimum length of stay criteria); in other countries they are considered outpatients, day patients or day cases.

  • outpatient or same day surgery

 

  • chemotherapy patients

 

  • renal dialysis patients

 

  • endoscopic procedures

 

  13.     Length of stay (discharge days)

The total number of patient days for an inpatient episode.  The duration of an inpatient’s hospitalization is considered to be one day if he is admitted and discharged on the same day and also if he is admitted on one day and discharged the next day.  The day of admission should be counted but not the day of discharge.

  14.     Live birth

       “The complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live born.”

                                                                                              WHO, ICD 10, Vol.1, page 1235

  15.     Maternal death

Death of any woman while pregnant, or within 42 days of termination of pregnancy, irrespective of duration and site of pregnancy, from any cause related to or aggravated by the pregnancy, or its management, but not from accidental or incidental causes.

Maternal deaths should be divided into two groups:

(1) Direct obstetric deaths

 

Those resulting from obstetric complications of the pregnant state (pregnancy, labour and puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above.

(2) Indirect obstetric deaths

Those resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiological effects of pregnancy.

                                                                                              WHO, ICD10, Vol. 1, page 1238

 16.      Neonatal death

The neonatal period commences at birth and ends 28 completed days after birth.  Neonatal deaths (deaths among live births during the first 28 completed days of life) may be subdivided into early neonatal deaths, occurring during the first seven days of life, and late neonatal deaths, occurring after the seventh day but before 28 completed days of life.

                                                                                              WHO, ICD10, Vol. 1, page 1237

  17.     Occasion of service

An occasion of service is a specified, identifiable service involved in the care of patient that is not an encounter, such as a lab text ordered during an encounter.  (Horton)  Any examination(s), consultation(s) or treatment(s) or other service(s) provided to a patient by a functional unit of a health service facility.  On each occasion such service, each specimen, or simultaneous set of specimens for the one patient, referred to a hospital department, constitutes one occasion of service.

  18.     Outpatient

An outpatient is a patient who receives care without being admitted to inpatient or resident care.

  19.     Patient day (inpatient service day)

A unit of measure denoting the services received by one inpatient during one 24-hour period.  

  20.     Perinatal death

A perinatal death is one occurring during the perinatal period, which commences at 22 completed weeks (154 days) of gestation (the time when birth weight is normally 500 g), and ends seven completed days after birth.

                                                                                              WHO, ICD10, Vol. 1, page 1237

 

NOTE:  In ICD9 it was recommended that countries should present, solely for international comparisons, “standard perinatal statistics” in which both the numerator and the denominator of all rates are restricted to fetuses and infants weighing 1000 g or more (or, where birth weight is unavailable, the corresponding gestational age (28 weeks).

                                                                                                    WHO, ICD9, Vol.1, page 766

  20.     Surgical procedure (Surgical operation)

Any single separate systematic manipulation upon or within the body which can be complete in itself, normally performed by a licensed practitioner or dentist, either with or without instruments, to restore disunited or deficient parts, to remove diseased or injured tissues, to extract foreign matter, to assist in obstetric delivery or to aid in diagnosis.

Although surgical procedure and surgical operation are considered synonymous here, a surgical operation is defined as one or more surgical procedures performed at one time for one patient via a common approach or for a common purpose.  (Horton)

  21.     Total length of stay (total discharge days)

The number of days of care rendered to a group of inpatients from admission to discharge. The sum of the length of stay of any group of inpatients discharged during a specified period of time.

  22.     Total patient days (total inpatient service days)

The sum of all inpatient service days for each of the days during a given period. This is taken from the census forms. Every inpatient receives one inpatient service day each day he/she is hospitalized. 

  23.     Transfer

The movement of a patient from one medical care unit to another within a hospital.  Transfers to another health care institution are classified as discharges.

  24.     Underlying cause of death

  • the disease or injury which initiated the train of morbid events leading directly to death; or

 

  • the circumstances of the accident or violence, which produced the fatal injury.

                                                                                              WHO, ICD10, Vol. 1, page 1235

 

B.   INPATIENT STATISTICAL DATA COLLECTION AND CALCULATIONS

Inpatient statistical data routinely collected and calculated in hospitals on a monthly and annual basis include:

  • number of admissions – total hospital and by service
  • number of patient days
  • number of discharges (live and expired) – total hospital and by service
  • number of deaths – total hospital and by service
  • total length of stay (total discharge days)
  • number of autopsies
  • number of Coroner’s (medical examiner’s) cases
  • number of deliveries (obstetric patients)
  • number of live births
  • number of fetal deaths
  • number of obstetric discharges
  • number of maternal deaths
  • number of perinatal deaths
  • number of surgical procedures
  • number of anaesthetics administered

 

       The above information is used to calculate the following rates and percentages:

 

(a)   Hospital utilization

  • daily census
  • average daily census
  • average length of stay of inpatients
  • percentage of occupancy of hospital beds
  • turnover interval
  • turnover rate

 

(b)   Death rate

  • hospital death rate
  • net death rate
  • postoperative death rate
  • anesthesia death rate

 

(c)  Autopsy rates

  • hospital autopsy rate
  • net autopsy rate

 

(d)  Obstetric and perinatal rates

  • caesarean section rate
  • maternal death rate
  • fetal death rate
  • perinatal death rate

 

The above rates and percentages may be calculated using the following

formulae:

1.    Hospital Utilization

  • Daily Census (Daily Bed Occupancy) 

 

Formula 

 

Census    =    Inpatients                 Admissions up       Discharges/deaths

remaining at              to the next                  between census

midnight the    +        census hour ‑           taking hours

previous night

  • Average Daily Census (Average Daily Bed Occupancy) 

 

The average number of inpatients present each day for a given time period.  This figure is derived by dividing the sum of patient days for a period by the number of days in the same period.


Formula 

 

Total number of patient days for a period (except newborn)          

Total number of days in the same period

 

Example

In May a hospital rendered 4,280 patient days (excluding newborn babies).  May has 31 days. Using the above formula the average daily census is calculated as follows:

4280

 31  =          138.06 or 138.1

This would be rounded to give the average daily inpatient census during May of 138 patients.

NOTE:  This indicator is calculated separately for newborns.

  • Average length of stay (ALOS) of discharged patients 

 

The average number of days that inpatients (exclusive of newborn) remained in the hospital.

Formula 

 

Total length of stay of discharged patients for a given period 

Total number of discharges and deaths in the same period

Example

In June a hospital discharged 2,086 patients (including deaths, but excluding newborns). Their combined length of stay was 13,654 days. Using the above formula the average length of stay of these patients was:

13654

 2086         = 6.54 or 6.5 days

  • Percentage of occupancy of inpatient beds 

 

The percentage of inpatient beds occupied over a given period.

 

Formula 

 

Total number of patient days for a given period x 100 

Available beds (bed complement) x the number of

days in the period

Example

A hospital with 210 available beds (excluding newborn bassinets) rendered 4,780 patient days in June.  June has 30 days.  The percentage of  occupancy for the hospital in June was:

4780 x 100           =          78000 =

          210 x 30                             6300              75.87 or 75.9%

  • Bed Turnover Interval 

 

Average period in days that an available bed remains empty between the discharge of one inpatient and the admission of the next.

Indicates the time that available beds are free.

Indicates a shortage of beds when negative, and under-use of the hospital or an inefficient admission system, if positive.

Formula 

 

Available beds x days in the period ‑ patient days for the period 

Number of discharges, including deaths, in the period

Example

A hospital with 210 available beds in June rendered 4,780 patient days and had 736 discharged/died patients.  The turnover interval rate using the above formula is:

210 x 30 ‑ 4780    =          1520

736                             736     =          2.06 or 2.1 days

  • Bed Turnover Rate

 

The mean number of patients “passing through” each bed during a period.

Indicates the use made of available beds.

Formula 

 

Number of discharges (separations) in the period 

Available beds

Example

During the month of June there were 736 discharges (including deaths) from a hospital with 210 beds.  The turnover rate for June was:

736  =

210                        3.50 or 3.5

2.    Death Rates

Note:       Patients who are dead on arrival (DOA) at a hospital are not included when calculating these rates.

  • Hospital Death Rate 

 

A ratio of all inpatient deaths for a given period to the total number of discharges and deaths in the same period.

 

Formula 

 

Total number of deaths of inpatients in a given period x 100 

Total number of discharges and deaths in the same period

Example

A hospital had a total of 15 deaths during the month of June.  A total of 540 patients were discharged (including the 15 deaths) during the month.  The hospital death rate according to the above formula is:

15 x 100

  540          =          2.77 or 2.8%

  • Net Death Rate 

 

 

A death rate, also known as the institutional death rate, that does not include deaths, which occur within 48 hours of admission (24 hours of admission in some countries).  Previously, it was that those deaths that occur within 48 hours of admission should not be counted because not enough time had lapsed to allow the health care providers adequate time to directly affect the patient’s condition.  However, with today’s technology, this concept is no longer thought to be valid.  Therefore, it is recommended that net death rates not be calculated unless there is a special order to do so.

Formula 

 

                        Deaths minus those w/in 48 hours of admission in a given period x 100

Total number of discharges and deaths, minus

Deaths w/in 48 hours of admission w/in the same period

 

Example 

Taking the above example, of the 15 deaths, 4 patients died under 48 hours, leaving 11 patients who died 24 hours or more after admission.  The total discharges, including deaths were 540. According to the formula the deaths under 48 hours of admission are deducted.  Therefore, the calculation of the net death rate would be as follows:

15 ‑ 4 x 100          =          11 x 100

     540 ‑ 4                               536                 =          2.09% or 2.1%

  • Postoperative Death Rate

 

The ratio of deaths within 10 days after surgery to the total number of patients operated on during that period.  Some healthcare providers question the usefulness of this rate, as it is questioned how ten days is considered the “magic number.”

Formula

 

  Total number of deaths(within 10 days of surgery)    X    100

Total number of patients who were operated on for the period

Example

During the month of November a hospital performed 275 operations, and 269 patients were operated on.  There were 2 deaths that occurred within 10 days of surgery, and 1 that occurred after 10 days.  The postoperative death rate according to the above formula is:

              2 X 100  = 0.74%

              269

Note:  it is recommended with small percentages of this nature, that the percentage be left at two decimal places.

  • Anesthesia Death Rate

 

The ratio of deaths caused by anesthetic agents during a specified period of time to the number of anesthetics administered. This formula includes those deaths that occurred within 10 days of surgery.

Formula

 

  Total deaths caused by anesthetic agents   X    100

         Total number of anesthetics administered

Example

During the month of August a hospital performed 750 operations, and 750 anesthetics were administered.  There was 1 death due to anesthesia.  The anesthesia death rate according to the above formula is:

              1 X 100    =    0.13%

              750

3.    Autopsy Rates

  • Hospital autopsy rate

 

The ratio of all autopsies performed in the hospital to all inpatient deaths in the hospital.  Patients who are dead on arrival (DOA) at the hospital and fetal deaths are excluded from both the numerator and the denominator

 

Formula

 

Total number of autopsies for a given period  x   100

Total number of inpatient deaths for the same period

Example

In a hospital with 15 deaths during the month of June, 7 autopsies were performed on hospital patients whose bodies were available for hospital autopsy.  The hospital autopsy rate is calculated as follows:

7 x 100

  15             =          46.66 or 46.7%

  • Net autopsy rate

 

A hospital may be prevented from performing an autopsy because the death is a coroner’s or medical examiner’s case and must be sent to the coroner’s court for autopsy.  It would not reflect the scientific interest of the doctors to include such cases in a measure of unautopsied hospital cases. Cases, which are not available for autopsy, are not included in the net autopsy rate.

Formula

 

Total number of autopsies for a given period x 100

Total number of deaths minus unautopsied

Coroner’s cases for the same period

Example

In the above example, of the 15 deaths and 7 autopsies in June 2 deaths were reported to the coroner/medical examiner and the bodies removed from the hospital and no hospital autopsy was performed.  The net autopsy rate, therefore, was:

7 x 100      =          700

15 ‑ 2                     13       =          53.84 or 53.8%

4.    Obstetric and Perinatal Rates

  • Cesarean section rate

 

A ratio of the number of cesarean sections performed to total deliveries.

Formula

 

Total number of cesarean sections performed in a period x 100

Total number of deliveries in the period

Example

During the month of May, 310 deliveries occurred.  Of this number 5 deliveries were by cesarean section.  Using the above formula, the cesarean section rate is calculated as follows:

5 x 100

   310         =          1.61 or 1.6%

  • Maternal Death Rate

 

The ratio of maternal deaths to total obstetric discharges, including deaths.  NOTE:  Deaths due to abortions are maternal deaths even though the patient may have been hospitalised on a gynaecology ward.

 

Formula

 

  Total number of maternal deaths for a given period    x   100

    Total number of obstetric discharges, including deaths,

                               for the same period

 

Example

During May an obstetric hospital discharged 230 obstetric patients, of this number, 1 patient died.  Using the above formula the maternal death rate would be:

1 x 100

230                        =          0.43 or 0.4%

  • Perinatal Death Rate

 

The ratio of perinatal deaths to live births and fetal deaths.         

Formula

 

Total number of perinatal deaths in a given period x 100

Total number of live births and fetal deaths in the same period

 

Example

In the month of May, there were 294 births, including 4 fetal deaths, and 2 babies subsequently died within seven days of birth.  The perinatal death rate for May, therefore, was:

6 x 100

   294         =          2.04 or 2.0%

  • Fetal Death Rate

 

A ratio of fetal deaths to the total number of live births and fetal deaths in a period.

                   Formula:

 

Total number of fetal deaths for a given period x 100

Total number of births and fetal deaths for the same period

Example

The fetal death rate, using the perinatal death rate example above, is calculated as follows:

4 x 100

   294         =          1.36 or 1.4%

C.   OUTPATIENT STATISTICAL DATA COLLECTION AND CALCULATION

 

  • number of outpatient visits
  • number of outpatient visits for each clinic
  • number of emergency department visits
  • occasions of service (i.e., number of special services, e.g. Ultrasound, X‑ray, pathology tests)

 

Most of the above are collected to assess the workload of each department or clinic, and plan for future needs. It may be found that the Wound Clinic staff see twice as many patients than other clinics, therefore more staff will be required in the clinic area on the wound clinic days; or, patient waiting time may be too long and the administration decides to look at the statistics for each clinic to see if it is because too many patients are given appointments when sufficient medical staff are not available.

This data may be manually tallied each day and totalled at the end of the time frame, or if a computerized patient registration system is used, the computer may automatically count these statistics.  Therefore, no formulae are necessary to calculate this information.

1.    Outpatient Visits (per day or per clinic session)

The average number of patients seen per day or per clinic session.

 

                   Formula

 

 Total number of visits in period     

Total number of days in the time period (or clinic session held)

Example

During the month of September the Wound Clinic was held 12 times and there were 287 visits.  Using the above formula, calculate the number of visits per clinic session.

287            =          23.92 or 23.9

 12

D.   REPORTS

Quite frequently, the health facility’s administrator, accreditation agency, or a government agency establishes various reports that must be presented. It is important to ensure that these reports are prepared in a timely and accurate manner since, directly or indirectly, this is one of the ways the health record department is evaluated.

The data collected and reports prepared should be reviewed and evaluated on at least an annual basis to determine if they are be used. Data that are collected for no apparent reason or reports that are prepared that no one uses are a waste of staff time and resources.

Sometimes reports prepared only present the work accomplished during the reporting period, and may not be particularly useful for problem identification or for decision-making. A report that compares selected data and indicators over different time periods may prove useful. 

For example, the data and indicators for a month and the year to date can be compared with data for the same month and year to date of the previous year.

                                                                        Current year                          Previous year

                                                                        Month    YTD                         Month     YTD

Admissions

Discharges

Deaths

Patient days

Average daily census

Average length of stay

Percentage of occupancy

Turnover rate

Outpatient visits            

 

E.   QUALITY CONTROL

Health record professionals are evaluated on the timeliness, completeness, and accuracy of the statistical reports they are responsible for preparing.  It is therefore important to have policies and procedures that help ensure that reports meet these criteria.

Policies and procedures should include the following points:

1.  Monitor that the Health Record Department receives all reports within the established time period (e.g., unit census reports received daily; operating room reports received within 5 work days following end of the month).

2.  Follow-up immediately on delinquent reports.

3.  Check each unit census daily to be sure that:

  • ·    every patient listed as a transfer in or transfer out appears as a transfer on the census report of another ward;

 

  • ·    the number of patients remaining at the end of the day agrees with the number obtained by adding to the patients remaining the previous day the number of entries to the ward (admissions and transfers in) and from this total subtracting the number of departures (live discharges, deaths, transfers out) from the ward.

 

4.  Verify that for the hospital as a whole the number of transfers in agrees with the number of transfers out.

5.  At the end of each day, month, and year (or other time period), check the hospital inpatient statistical report as outlined in point 3 above.

6.  Check all indicators for accuracy and to be sure that they make sense.  For example, the number of patients remaining at the end of the time period should be lower than the number of beds unless, of course, more than one patient occupies a bed.

7.  Proofread all reports before distribution to be sure that they contain no typographical errors.

SUMMARY:

Before proceeding to collect or compute any statistical information, the health record professional must find out what is needed and how and when it is to be used.

The reports generated are also very important and are used as a tool of communication.  All presentations should be simple and readable with important facts highlighted.  Although most reports will be in tabular form, they would be easier to read if visual aids such as graphs, bar charts and pie diagrams were used to illustrate clearly what the figures indicate.

In addition, reports should be clear and concise, and leave no doubt as to what the figures represent.

Many health facilities around the world today use computers to analyze and present their statistical data.  This often results in the collection of more than basic data, which is readily retrievable and useable.

To assist in your understanding, complete the following exercises in Appendix 1.  Answers are included in Appendix 2, but please work through each exercise before checking your answers.  If any of your answers are incorrect, work through them again to find out where you went wrong.

REFERENCES:

1          Davis, Nadinia, and LaCour, Melissa.  Introduction to Health Information Technology.  Philadelphia, PA:  W.B. Saunders, 2002.

2.         Horton, Loretta A.  Calculating and Reporting Healthcare Statistics.  Chicago, IL:  AHIMA, 2004.

3.         Huffman, Edna K. Health Information Management.  10th ed. Berwyn, IL:    Physicians Record Company, 1994.

4.         Johns, Merida, ed.  Health Information Management Technology: An Applied Approach.  Chicago: AHIMA, 2002.

5.         Skurka, Margaret.  Health Information Management:  Principles and Organization for Health Information Services.  San Francisco, CA:  Jossey- Bass, 2003.

6.         World Health Organization (1994). International Classification of Diseases and Related Health Problems, 10th Revision, Volumes 1, 2 &3.  Geneva: WHO.

Appendix 1 – Excercises

Education Module 4 – Healthcare Statistics

 

 

 

EXERCISE 1 – Patient Care Unit CENSUS

 

1.  Using the information on the left of the page, complete the daily midnight census for Unit A.

UNIT A                                                           BED RETURN FOR DATE 3/6/2006

John Smith adm. from                                 a.         No. in ward last report         40

O.P.D. (Dr. Richard)

Adam James adm. Dr. Maurice                             No. admitted               ______

Stanley Paul adm. G.P.                                          No. transfers in           ______

Anthony Greech trans.                               b.         Total                            ______

from other hospital

Patrick Sterling trans.                                              No. discharges            ______

from Med. (Ward B)

Gordon Thompson died 10.30 a.m.                      No. Deaths                  ______

Wayne Johnson emerg. adm.                               No. transfers out          ______      

Brett Arnold disch. O.P.D.                          c.         Total                             ______

Michael Stephens disch. G.P.      

Adam Carpenter trans.                                            Today’s census

to Psych. (Ward D)                                                        a + b – c     =             ______

John Trip trans. to

other hospital

Wayne Johnson died 4.30 p.m.

John Smith disch. O.P.D.

Thomas Adams disch. O.P.D.

2.    Calculate the number of patient days for Ward A on 03/06/2006:

EXERCISE 2 ‑ HOSPITAL CENSUS REPORT

 

            Date:  ____________

Directions:         Complete the data for Unit A from Exercise 1.

                             Complete the Hospital Census report.

                             What checks for accuracy can you use?

 

Unit

 

Prev.

Day

Census

 

Admi-

ssions

 

Transfers

In

 

Discharges

 

Transfers

Out

 

Today’s

Census

 

Alive

 

Deaths

 

A

 

 40

           
 

B

 

 35

 

 4

 

2 from C

       
 

C

 

 23

 

 8

   

 4

   

 2 to B

 
 

D

 

 28

 

 3

   

 2

 

 1

   
 

E

 

 30

 

 6

   

 3

     
 

TOTAL

 

156

           

 

                                          EXERCISE 3 ‑ HOSPITAL CENSUS

Complete today’s hospital census report

HOSPITAL CENSUS REPORT

 

August 27, 2006.

 

Unit

 

Prev.

Day

Census

 

Admi-

ssions

 

Transfers

In

 

 Discharges

 

Transfers

Out

 

Today’s

Census

 

Discharges

 

Deaths

 

A

 

 40

 

 3

   

 2

   

2 to B

 
 

B

 

 26

   

 2 from A

 

 4

 

1

 

1 to D

 
 

C

 

 31

 

 8

   

 5

 

1

   
 

D

 

 45

   

 1 from B

 

10

   

2 to C

 
 

E

 

 12

 

 6

         
 

TOTAL

 

154

           

 

 

                                                               EXERCISE 4

1.    Compute the length of stay of 10 patients who were discharged from hospital on October 6, 2006.  Their dates of admission were as follows:

(a)        September 12                ______           (f)        September 11           ­______

(b)        September 28                ­______           (g)       October 5                   ______

(c)        September 30                ______           (h)       September 16           ______

(d)        September 26                ______           (i)         October 6                   ______

(e)        October 4                        ______           (j)         August 13                  ______

(k)        What was the average LOS?   ________

2.    In a 200-bed hospital, the patient days for 2006 were 62,050.   The 6,495 patients who were discharged or died had a total of 61,930 days care.  Using the above figures, compute the following averages and rates, showing formulae used.

(a)        Average daily census for 2006

(b)        Percentage of occupancy for 2006

(c)        The average length of stay of discharged patients during 2006

 

EXERCISE 5

1.    A Coronary Care Unit in a large teaching hospital had a total bed count of 20 beds in 2006.  During the year the patient days for the unit were calculated at 5,260 days.  The 1,255 inpatients that were discharged from the unit during 2006 spent a total of 5,066 days there.

       a.         How many patients, on the average, were cared for in the unit per day?

       b.         How long, on the average, did patients remain in the unit?

       c.          What percentage of beds were occupied during the year?

2.    The following data have been collected from a 700-bed general hospital during 2006:

Patients admitted                                                       14,117

Total discharges/deaths                                           14,086

Total discharge days                                               137,202

Total inpatient patient days                                    226,842

Total registered outpatient attendances              192,846

From the information above, calculate the following, showing formulae:

a.         Average length of stay

b.         Average daily census

c.          Percentage of occupancy

3.    In a local hospital, the average length of stay in January 2006 was 10.4 days.  The number of patient days care rendered to discharged patients in the same period was 5,460.  How many discharges were there in January?

4.    A 460 bed general hospital assigned 215 beds for general medical service, 125 beds for General surgery including Orthopedics, the remainder, 120, were divided among the other services.  For the past 12 months (2006) the number of patient days within the three major categories were:‑

A.         General medicine         59,059

B.         General surgery                        43,070

C.         Other services               35,040

Using the above information, calculate the following for each of the three categories:

  • Percentage of bed occupancy
  • Average daily census

 

 

EXERCISE 6

A 477-bed general hospital had 15,746 patients discharged/died in 2006.  Total deaths for the year were 487.  There were 81 cases reported to the Coroner, and 351 autopsies were performed.

Total patient days were 136,995 and the total length of stay of discharged/died patients was 136,540. 

Give the formulae, and using the above information compute the following:

1.    Hospital death rate

2.    Bed turnover rate

3.    Net autopsy rate

4.    Average length of stay

 

EXERCISE 7

1.    The following data have been collected from a local hospital.  The average length of stay in June was 5.2 days.  The total length of stay of discharged/died patients in the same period was 2,730.  There were 18 deaths, including 2 unautopsied Coroner’s cases and 12 autopsies were performed.

a.         What was the hospital death rate?

b.         What was the net autopsy rate?

2.    The following data have been collected from a 700 bed general hospital during 2006:

Patients admitted                                                                      19,957

Total discharges/deaths                                                           19,933

Patients remaining in hospital midnight

Dec.31, 2005                                                                                              632

Patients remaining in hospital midnight

Dec.31, 2006                                                                                             656

Total length of stay of discharged/died patients                218,515

Total patient days                                                                 236,842

Total deaths                                                                                               615

Total autopsies performed                                                           485

Coroner’s cases (unautopsied)                                                     43

Number of anaesthetics administered                                    6,925

Number of operations performed                                            7,700

Total registered outpatients                                                192,846

From the information above, calculate the following:

a.        Average daily census

b.        Hospital death rate

c.         Turnover interval

d.        Gross autopsy rate

e.        Net autopsy rate

f.         Percent of occupancy

g.        Average length of stay

 

EXERCISE 8

The following information was collected from a 500-bed hospital and includes the census figures for the 30th September, 2006, and the monthly figures for the month of September, 2006.

(a)  September 30

Patients in hospital at midnight                        418

Patients discharged 30th September                 17

Patients admitted 30th September                     24

(6 patients were admitted and discharged

the same day.)

(b)  September, 2006

Total number of discharges/deaths                 1088

Total deaths                                                                                     43

Coroner’s Cases (unautopsied)                             4

Total number of autopsies performed                 28

Total number of anaesthetics administered     467

Total number of outpatient attendances       16203

Total patient days during September             12332

Total length of stay of discharged/died        

patients                                                    10943

From the above figures, calculate the following:

1.    Census for the 30th September

2.    Patient days for 30th September

3.    Average daily census

4.    Percentage occupancy

5.    Average length of stay

6.    Gross autopsy rate

7.    Bed turnover rate

8.    Hospital death rate

9.    Net autopsy rate

EXERCISE 9

1.    In an obstetric hospital there were 310 live births in June 2006; of this number 7 died within the neonatal period.  The hospital also registered 8 fetal deaths for the same month.  What rates were calculated below?

a.        (8 + 7) x 100 divided by (310 + 8) = 4.72 or 4.7%

b.        8 x 100 divided by (310 + 8) = 2.52 or 2.5%

2.    An obstetric hospital published the following figures in 2006:

Obstetrical discharges

  • delivered                                      2288
  • undelivered                                  327
  • aborted                                            39

Total infants discharged/died                         2255

Total births (live)                                                2309

Infant deaths (early neonatal)                            56

Fetal deaths                                                            36

Maternal deaths                                                         3

Using the above information, calculate the following:

a.  Maternal death rate

b.  Infant death rate

c.  Fetal death rate

d.  Perinatal death rate

3.    A 320 bed obstetric hospital had 10,220 obstetric separations in 2006. There were 7,016 live      births; 139 fetal deaths; 523 caesarean sections were performed with a total of 6,968 deliveries for the year and 2 maternal deaths.  There were 4 infant deaths classed as early neonatal.  Using the above information, calculate the following:

(a)       Fetal death rate

(b)       Cesarean section rate

(c)       Perinatal death rate                     

 

EXERCISE 10

You have received the following medical statistics for review prior to their publication in the 2006 Annual Report of a General Hospital.  What comments do you have regarding the accuracy of the data?

Available beds (Bed complement)                                                                                    430

Total admissions                                                                                                 11,285

Total discharges/deaths                                                                                    11,123

Total deaths                                                                                                              521

Patients in hospital at midnight on 31 December 2005                                                 344

Patients in hospital at midnight on 31 December 2006                                                371

Autopsies performed (including 2 autopsied Coroner’s Cases)                     378

Coroner’s cases                                                                                                                      44

Total patient days                                                                                              128,954

Total length of stay of discharged/died patients                                          126,872

Out‑patient visits                                                                                               106,750

Average daily census                                             352

Percentage of Occupancy                         81.9%

Turnover rate                                                25.9

Hospital death rate                                      46.8%

Gross autopsy rate                                         0.73%

Net autopsy rate                                             0.79%

 selesai @ hak cipta dr Iwan suwandy 2010

Modul Pelatihan Praktisi rekam Medis Unit 3 ” Record Identification syatem,Filing and Retention Of Health Record”

Education Module for Health Record Practice

based on IFHRO Modul

UNIT 3 ‑ RECORD IDENTIFICATION SYSTEMS, FILING AND RETENTION OF HEALTH RECORDS

This unit introduces the participant to different record identification and filing systems used in health record management.  Record identification may be either alphabetic or numeric, and the filing system used is dependent upon the type of record identification system employed.  Although some health care facilities have electronic health records,  most health care facilities still maintain patient records in a paper-based format.  

This unit deals with the various methods to identify and file paper-based patient records.

The record identification and filing systems form the first step in a series of procedures in the management of health record services.  A medical record has no value if it cannot be found once it is stored somewhere in the file area.

Careful planning of the record identification and filing systems to be used is of great importance.  The choice of the system, however, also depends on the specific type and circumstances of the health care facility for which it is selected.

Planning of filing activities should also include a policy on record retention.  Storage space is generally a scarce commodity, so usage of it has to be maximised.

OBJECTIVES:

Upon the completion of this unit, the participant should be able to:

1.     compare and contrast the different methods of record identification and list the advantages and disadvantages of each

2.     give specific examples of serial and unit numbering

3.     explain what is meant by a unit numbering system

4.     compare and contrast filing systems for health records.

5.     explain relational numbering with advantages and disadvantages

6.     define record linkage and explain how it is used

7.     demonstrate an understanding of terminal digit filing and cite the advantages and disadvantages of its use.

8.     define what is meant by a centralized filing system and delineate the advantages of this system

9.     describe the methods that may be used to assign patient healthl record numbers

        10.     explain the various control methods used to facilitate the location of health records

        11.     state the general rules for record control in a hospital or clinic and the specific filing rules required to maintain an efficient health record service

        12.     identify and compare the different types of filing equipment used to file health  records

        13.     delineate characteristics which should be considered in choosing folders, guides and outguides

        14.     outline criteria which must be evaluated when establishing record retention policies

        15.     explain the storage options for health records with advantages and disadvantages.

A.      RECORD IDENTIFICATION SYSTEMS

It is important that each record has a unique identifier, either alphabetic or numeric. The collection of patient identification data and the assignment of a record number or verification of an existing record number should be the first step of every admission or visit to a hospital or health center.  It is the only way to ensure properly identified health records.

          1.     Alphabetic Identification

The simplest form of record identification is alphabetic, using the patient’s name to identify and file the patient’s health record.  And because only the patient’s name is used to identify the record, it is also the easiest method of record retrieval, as the master patient index (MPI) is not needed to cross-reference the patient’s name to the health record number.  The accurate spelling of the patient’s name is of extreme importance.  It is also important to create a system to track name changes, such as from marriage or divorce.  It is necessary to thoroughly train staff to verify patient names and spellings, and to accurately and consistently file the health records.

One concern with this type of record identification is patient confidentiality.  Since the outside of the record is identified only with the patient name, and not a number, the patient’s identity is not protected.

This type of record identification system is most practical in smaller health care facilities with stable patient populations.  Larger patient populations would result in multiple patients with the same name, leading to possible mix-ups of patient files.  It is also most practical for facilities with little or no computerization. 

2.     Numerical Identification

A numerical record identification system requires that a unique health record number be assigned.  It requires the use of a MPI to cross-reference the patient’s name with his or her health record number.

There are two main systems of numbering patient records:

  • ·Serial numbering
  • ·Unit numbering

 

a.  Serial numbering

With this method the patient receives a new health record number on every inpatient admission or outpatient visit to the hospital or clinic.  That is, the patient is treated as a new patient each time with a new number, new index card and new record, filed totally independently from previous records.

Serial numbering is not used extensively today and is only useful in small hospitals with a low rate of readmission.

b.  Unit numbering

The patient is assigned a unique identification number on his first contact with the hospital, whether it is for an admission, emergency room or outpatient clinic visit.

The same health record number is kept and used on all subsequent visits, whether as an inpatient, outpatient or emergency patient. A unit health record number results in the creation of one, central health record for the patient.

This number is normally related to one single record, where all the information on the patient is brought together.  These data can originate from different clinics or units, at different time periods. If a unit record is not possible, the unit numbering system can be used to link health records that are physically located in different places.

      1) The advantages of using a unit number for filing are:

  • the number is unique to the individual and therefore distinguishes him/her from any other patient in the hospital or clinic

 

  • the number does not change regardless of how often a person is admitted to hospital or attends a clinic

 

  • patients’ health records are centralized in a single folder

 

  • this system provides the medical staff with a complete picture of the patient’s medical history and treatment received over a number of admissions and attendances.

 

  • health records are filed in one place.

 

      2)    The disadvantages of using a unit number for filing are:

  • health records may become quite thick and additional folders may be required

 

  • space needs to be allocated to allow for the expansion of records as more admissions are added to a folder.

 

It is important to note that when a unit record is used, it is essential for all staff to check the patients’ master index before issuing a new record folder.  This ensures that a duplicate health record is not produced.

  1. Serial-unit numbering

 

Serial-unit numbering is an adaptation of the serial and unit numbering systems that combines both systems.  With this system, the patient receives a new number on every contact with the hospital, but previous records are brought forward and filed under the latest number, so only one record will remain in the files.

It is necessary to leave either the old health record folder or an outguide (or tracer card), referring to the new record number, in the place from where the old records are removed.

1) The advantages of serial‑unit numbering and filing are:

  • §a unit record is created

 

  • §record retention is easier as records with lower numbers automatically remain in the old file.

 

2) The disadvantages of serial-unit numbering and filing are:

  • §gaps are left in the file area when medical records are brought forward.

 

  • §time is needed for back shifting and for cross‑reference from old record and record number to the newest one. (Huffman 1994)

 

d.  Conversion to a unit system

The change from one system to another should not be underestimated.  It implies an increased workload, since two filing systems have to be used for an undetermined period of time.  Many records have to be controlled and shifted, especially in the first months.

      The steps proposed for a conversion are:

      1)    Select a date to make the change, and begin issuing patients new unit numbers on that day.

      2)    Check if the patient already has a record (or records).  Bring forward these previous records and file them under the new number.

      3)    It is best to convert the records of old patients to the new system as they come back to the health care facility, rather than attempt to convert the entire file at one time.

      4)    The Master Patient Index has to be adjusted or a new MPI started from day one of the changeover.   As a dual control, empty folders of previous records or out guides (tracers) should be left at the original places in the old file, with cross‑reference to the new unit record number.

      5)    After a predetermined period of time, the records still in the old file can be considered as inactive and eventually removed to inactive storage.  This also applies to old MPI cards, if a new MPI was started.

2.     Types of numbers

a.  Sequential numbering

Records are assigned a sequential number in chronological sequence commencing at 1.  For example, if the last number to be assigned was 010524 the number issued to the next patient would be 010525.  This method is simple, easy to assign, and easy to control.

This is the way numbers are issued in both serial and unit numbering systems.

Often when using a serial numbering system, some hospitals connect  this sequential numbering system with the year as a prefix, for example:

     05‑0024, represents the 24th patient of 2005

Other types of numbering are described below.  They are not generally considered to be better than a straight numbering method, nor as commonly used.

b.  Alphanumeric numbering

This is a combination of letters and figures, for example:

     AA 99 99 instead of 99 99 99

This method has the advantage of a greater capacity with the same number of characters, for example, letters:  A‑Z (26); figures: 0 to 9 (10).

This method, however, is not extensively used.

c.   Relational numbering

Relational numbers are numbers that, totally or partially, have a certain significance in relation to the patient.  There are various types of relational numbering systems that may be used, including:

   1)    Birth number

This number is derived from the date of birth.  That is, the number is based on six of the eight digits of the birth date.

To these digits other digits may be added.  For example, two, three (or even more) digits for the serial number (can be odd for males and even for females), a digit for gender, or digits representing a geographical code, for example:

    50            06                24            1                  05                    2

  Year      Month             Day         Gender       Serial       Geographic

Number          Code

In addition, one or two check digits may also be included, particularly, in computerized systems.  The total number, therefore, could consist of 9 to 12 digits.

           a) The advantages of using a relational number include:

  • The record number has built‑in information (age and sex)

 

  • Easy to remember, because of date of birth.  If difficulties occur in retrieving information from the MPI (misspellings, husband’s name, common names, etc.) the date of birth gives enough information to find the record.

 

   b) The disadvantages, however, must be taken into consideration, and include:

  • Long number, increasing the risk of transcribing errors, particularly in non‑automated systems.

 

  • A limited capacity, since a maximum of 31 numbers can be used for the day digits and a maximum of twelve numbers for the month.  Only the year digits have a range of 00 to 99.

 

  • If the birth date is unknown pseudonumbers (eg. 99 99 99) have to be used, and conversion procedures must be developed once the birth date is available.

 

  • Folders and MPI cards cannot be prenumbered.

 

 Although useful for identification, it is not generally considered a 

 good number for filing purposes.

   2) Social security numbering

Social security numbers are used, mainly in the USA and in some countries where the social security administration operates health facilities, but are also not recommended for filing purposes.

        a) Advantages of using a social security number are:

  • It is a unique identification number.
  • No reference to the Master Patient Index is necessary, and therefore faster retrieval.

 

  b) The disadvantages, however, outweigh the advantages and 

       include:

  • Some patients do not have or cannot give a social security number at the time of their admission or visit (eg. newborns, children, patients from abroad). Pseudonumbers must be assigned if no actual social security number is present, and again conversion procedures are needed, once the real social security number is available.

 

  • Threat of identity theft.

 

  • Control and verification of the number is out of the hands of hospitals using it.

 

3)  Family numbering

Another type of number used is a family number.  This type of numbering system is most appropriate for primary care clinics where all members of a family may receive health care.

With this system one unit number is issued to a household, and extra digits are added to indicate every individual in the household.

Example:       01        =          head of household

                02        =          spouse

                03        =          children and other family members (con’t)

                04

                05

                 06

Examples:

Mrs. Mary Smith            01 6436          Pamela Smith           03 6436

Mr. Donald Smith         02 6436          John Smith               04 6436

All health records are then grouped numerically by families, but separate folders can be maintained for each individual patient.

a)    The advantage of this method is that it is useful for ambulatory care centers, which emphasise the family as a unit (eg. family counselling).

b)    The major disadvantage is that families change.  Marriage and/or divorce cause changes of household number and/or extra digits.

When it is important to link family numbers a combination of a family number with another individual number is suggested.  It is safer and easier to use.

3.     Assignment of numbers

As previously mentioned, whatever method of numbering used it is important to have a unique identifier (medical record number) as soon as possible. The gathering of patient identification data and the assignment of a medical record number to new patients should be the first step of every admission or visit to a hospital or health center. 

How health record numbers are assigned is dependent upon if the registration process and MPI are computerized or manual, and if unit or serial numbering is used.

a)  Manual system

In a manual system that uses unit numbering, the responsibility for number allocation is retained in one place, usually the health record department. This ensures that controls are in place to prevent more than one patient from having the same number, or that a patient will have more than one number.  If a new patient arrives at a registration area, the health record department is contacted in order to get a new number.

The procedure for assigning numbers should be clearly recorded and monitored.

In a manual system that uses serial numbering, either the health record department may issue the numbers or the registration staff may be responsible.  If the registration staff assign the health record numbers, predetermined blocks of numbers are often issued to patient registration areas having a high volume of new patients.  The amount of numbers in each “block” should be determined by the activity of each area and should be limited and carefully controlled.  Since each area is allocated a specific block of numbers, duplicate numbers should not be assigned.

b)  Computerized system

The best system for number assignment exists in facilities having computerized registration and unit numbering.  With computerized registration, number assignment in every registration area is possible because computer systems are available to check the MPI and to verify that the patient does not have an existing medical record number.  As the patient is registered, the staff searches the computerized MPI database to determine if the patient has already been assigned a unit number.  If so, the demographic information is updated as necessary and the current visit information is entered.  It is important to note, however, that if more people are responsible for assigning numbers, the risk of duplication will increase.

4.     Number control

It is important in both manual and computerized systems to have an established method of number control.  Numbers should not be pre‑assigned unless good control processes are in place.

In a manual system, this can be a permanent number index, or master control book, where all assigned and unassigned numbers are held.  As a number is allocated the name of the patient is immediately entered beside that number.  Date of issue is also recorded.

For example:

Number                Name                         Date                Where issued

102642                Brown, John             09/27/2004    Outpatient Department

102643                                                    Miles, Andrew           09/27/2004    Outpatient Department

102644                West, Julia                09/27/2004    Admission Office

In computerized systems, a check digit is determined by performing some calculations on the basic number.  Thus, check digit verification is a way of detecting errors, caused by transcription of a data field or transposition in the use of the number.  It contains information about the magnitude and the position of each digit in the field.  Transcription (a wrong digit) or transposition (two digits reversed) errors lead to a calculation result, different from the check digit, and therefore an error message will be printed.

The way a number is presented also adds to the efficiency of the system. For example, an all-numeric number, presented in a fragmented form (eg, 10 26 42) or in boxes helps to reduce the misquotation rate.

5.     Record linkage or longitudinal records

The main goal of record linkage is the centralization of all medical data about a particular patient to enable essential information, about that patient, to be more readily accessible, and thereby creating a longitudinal record.  This type of system requires the use of electronic health records in order to share patient information.

Hospitals and governments, concerned with an expanding volume of medical information, are developing systems, designed to link all health records belonging to one patient that are physically located in different buildings or hospitals, within a city, state or province or across a country.

In order to link records or data within or between hospitals, accurate and fast patient identification and number assignment are of prime importance. As mentioned previously, in many countries a unique number, often based on the birth date, is assigned at birth, and remains the standard identifier during the individual’s lifetime.  This system readily enables record linkage.

 

The perfect standard identifier, and thus the perfect record linkage number, should be:

  • §    unique (assigned to one person only)
  • universal (covering the population involved, eg. hospital or nation)
  • §    permanent
  • §    available (it must be present on each of any pair of records to be linked)
  • §economical (it should consist of no more characters of information than necessary, as each character creates additional computer storage space).

 

It should also be noted that controversy exists surrounding the use of unique personal health identifiers because of the possible security issues, and many view it as a means of invasion of privacy

 

B.      FILING SYSTEMS

Record identification systems and filing must go hand‑in‑hand, as the filing system depends on the identification system used.  Filing is the systematic arrangement of records in a specific sequence so that reference and retrieval is fast and easy.

Daily procedures in many areas of a clinic or hospital can be severely affected by poor management of health record services.  It is therefore the responsibility of the health information professional/health record administrator to establish systems and procedures to ensure the efficient production of health records for patient care, medico‑legal purposes, statistics, teaching and research.

The health record department is judged on the efficient service it provides to the rest of the hospital or clinic. That is, health records must be readily available when required for patient care.  Departmental efficiency and record control are therefore two of the most important things to consider in the management of the health record services.

1.     Alphabetical filing                   

When no health record number is assigned, and the patient’s name is the only identifier, then alphabetical filing is the only possible method to use.  Filing is by patient surname first, then given name, and finally middle name or initial.  Records of patients with exactly the same name should then be filed according to their date of birth date.

This type of filing is time consuming and the risk of errors (change of name, misspelling) is extremely high.  Moreover, there is no way to control the use of the file area as it is not possible to know beforehand where the next new record will be filed.  Since names are not equally distributed, it is extremely difficult to avoid congestion areas and back shifting to open new file space.

Alphabetical filing is not recommended, and is only useful for facilities with a limited patient population and a small files area, with a very low patient turnover rate.

 

2.     Numerical filing systems

If a numerical record identification system is used, then a numerical filing system is used.  There are two main systems of filing records numerically:  straight numeric and terminal digit.

a.  Straight numerical filing

In this system, health records are filed in straight numeric sequence as follows:

8984                   108264

8985                   108265

8986                   108266

8990                   108267

This filing method reflects exactly the chronological order of the creation of records.  Straight numeric filing is typically used when serial health record numbers are assigned, however, a unit health record number may also be filed in straight numerical order.

1)    The advantages of straight numeric filing include:

  • people are used to this “logical” order and training is easy

 

  • easy to retrieve consecutive numbers for research or inactive storage.

 

2)    The disadvantages, however, outweigh the advantages, particularly in large hospital health record departments.  The disadvantages include:

  • easy to misfile, one must consider all the digits of the number in order to file the record

 

  • easy to transcribe numbers where one digit is wrongly written or read, for example: 1 for 7

 

  • easy to transpose numbers (reverse digits), for example, record number 194383 is filed as 193483

 

  • the highest numbers represent the newest, and therefore most active records, causing a concentration of record activity in one particular area of the file room, where these records are filed

 

  • it is not feasible to assign filing responsibility to one clerk since most of the records and loose sheets are filed in the same area.

 

b.  Terminal digit filing

1)    Whether using a serial, unit, or serial‑unit numbering system, the actual method used for filing is most important.  In place of straight numerical filing, other methods have been designed to improve retrieval and filing efficiency.  The most popular method in use today is the terminal digit filing system.

In terminal digit filing a six or seven digit number is used and divided into three parts.

Part 1 ‑    The primary digits, which are the last two digits on the right hand side

Part 2  ‑   The secondary digits, which are the middle two digits

Part 3 ‑    The tertiary digits, which are the first two or three digits on the left hand side

                                For example, the number 14 20 94 is divided as follows:

14                ‑             20                  ‑              94

Tertiary                   Secondary                     Primary

      2)    In the terminal digit file there are one hundred (100) primary sections ranging from 00 ‑ 99. When filing, the clerk considers the primary digits first, for example, the number 14 20 94 will be filed in the “94” primary section.  Within each primary section there are 100 secondary sections, also ranging from 00 ‑ 99.  The number 14 20 94 is filed in the 20 ‑ 29 secondary part of the “94” primary section.  Within the 20 ‑ 94 section the record is then filed in numerical order by the tertiary number.  The sequence of the file is as follows:

13 20 94             02 21 94                     11 21 94

14 20 94             03 21 94                     12 21 94

15 20 94             04 21 94                     13 21 94

16 20 94             05 21 94                     14 21 94

17 20 94             06 21 94                     15 21 94

18 20 94             07 21 94                     16 21 94

19 20 94             08 21 94                     17 21 94

00 21 94             09 21 94                     18 21 94

01 21 94             10 21 94                     19 21 94

      3)    The file clerk considers the record number in parts, going from the right to the left.  For the number 142094 he first locates the primary section (94). Within section 94 he looks for the secondary or subsection (20). There he files in numerical order, using the tertiary digit 14.

Adaptations can be made when more or less than six numbers are used.

 

        For example:

02               ‑                   44                    ‑           87

107          ‑           09                    ‑           14

      4)    The advantages of terminal digit filing include:

  • Records are equally distributed throughout the 100 primary sections.

 

  • Only every 100th new medical record will be filed in the same primary section of the file.

 

  • Congestion of personnel in the filing area is eliminated.

 

  • Clerks may be assigned responsibility for certain sections of the filing area.

 

  • The work can be evenly distributed among file clerks.

 

  • Inactive health records may be pulled from each terminal digit section as new ones are added, thus eliminating the need to backshift records.

 

  • Misfiles are substantially reduced with the use of terminal digit filing

 selesia@hak cipta Dr iwan Suwandy,MHA 2010