Executive Summary
Prepared by the Health Information Advisory Committee, this report aims at providing a comprehensive analysis of the problem of wastage and excessive expenditure on the components of medical recording at the Summer Bay Hospital. The report describes the causes of wastage and excessive expenditure through a discussion of the current costs of printed and unprinted components. It also examines the costs of products given by suppliers. Finally, it provides comprehensive recommendations for improvement through reducing costs on medical recordings at the hospital.
Introduction
Background to the problem
The Summer Bay Hospital has been experiencing problems associated with an increased rate of wastage and excessive expenditure in the medical records section. It was observed that the main area of wastage was in the components of medical recording, including the printed and unprinted components.
Aims of the project
The Health Information Advisory Committee was set up to develop a comprehensive analysis of the problems facing the medical recording system at Summer Bay Hospital. The hospital needed to reduce the expenditure and wastage on the medical recording components. The committee gas developed a report that includes discussions of current costs of printed and unprinted components. It also discusses the best way of reducing costs of the purchased items and recommendations in order to ensure that wastage of the medical record components is reduced significantly.
Methods
The committee has embarked on a data collection methodology that targets information from different representatives from a wide range of different departments. The committee has also contacted various different supply agencies in order to gain a better understanding of the costs associated with paper-based medical records.
Current components of the health record and their costs
Unprinted components
- Plastic covers/ Sleeves $51.00 per 500
- Clips $45.00 per 500
- A4 Plastic Record Protector Single Gusset $2.25 each
- A4 Plastic Record Protector Double Gusset $2.30 each
- Storage Pockets For Patient ID Labels $34.60 per 250
Printed components
- Discharge summary 100p $20.60 250p $40.80 500p $60.99
- Total progress notes 100p $14.70 250p $27.20 500p $47.75
- Investigations 100p $17.60 250p $30.00 500p $45.30
- Covers 100p $ 15.20 250p $27.00 500p $42.30
- Alert labels 100p $ 13.00 250p $25.00 500p $46.44
- Allergy/Drug reaction 250p $17.35 (RED LARGE)
- Dividers (Colour) 100p $16.50
- Patient ID stickers (black) 100p $19.00 250p $35.00
Comparison of printing costs between the current company and printing and supplies RUS
Unprinted components
- Plastic covers/ Sleeves $50.00 per 500
- Clips $44.00 per 500
- A4 Plastic Record Protector Single Gusset $2.15 each
- A4 Plastic Record Protector Double Gusset $2.10 each
- Storage Pockets For Patient ID Labels $33.60 per 250
Printed components
- Discharge summary 100p $19.60 250p $38.80
- Total progress notes 100p $14.70 250p $27.20 500p $47.75
- Investigations 500p $50.00
- cover 250p $150.00
- Alert labels 100p $ 11.00 250p $23.00
- Allergy/Adverse drug reaction 250p $17.35 (RED LARGE)
- Dividers (Colour) 100p $15.50
- Patient ID Labels 100p$ 18.00 250p $33.00
$ 14,024 less 2804.8 readmitted each year = 11,220
Each new patient in the current set up costs the hospital a total of $1.46 in printing and supplies cost. These are the times that, with the number of admissions (14,024), give a round figure of $20,475 per year. When the number of readmissions are added (2805), it takes the price of total printing and supplies up to a whopping $28,665.
For each initial patient’s episode of care we would require one cover one clip one alert label, two dividers, one sheet of patient labels, one discharge summary, two pages of progress notes and one investigation/procedure page.
- 1 x Cover 65c
- 1 x Clip 11c
- 1 x Alert labels 7c
- 2 x Dividers 17c
- 1 x Patient labels 16c
- 1 x Discharge summary 10c
- 1 x Progress notes 10c
- 1 x Investigation/Procedure page 10c
- Total new patient episode cost = $1.46 per patient
Problem identification and recommendation for improvement
The committee has identified a number of problems associated with the process of compilation of medical records in terms of wastage and cost at the Summer Bay Hospital. This section outlines the issues identified and the solutions expected to help the institution improve the efficiency and effectiveness of the printed and unprinted components of its medical records.
The Health Information Advisory Committee has noticed that the Summer Bay Hospital is reluctant to order many of its supplies in bulk. The hospital’s practice of ordering supplies in terms of minor packages contributes significantly to the increase of costs. To solve this problem, the committee recommends the practice of bulk buying to all employees of the Summer Bay Hospital. For example, the total progress notes ordered in packs of 100 have a unit cost of 15 cents, whereas a pack of 500 has a unit cost of 10 cents. The proposed new practice may lead to significantly larger savings for the Summer Bay Hospital.
Secondly, the committee has identified that the current printing company contracted by the Summer Bay Hospital has relatively higher costs of its services compared to other available companies, especially in regards to specific items such as paper components of the medical record including dividers, covers and a variety of individual pages.
To solve the problem, the Health Information Advisory Committee recommends the institution to find another company. In addition, the committee suggests that the hospital will achieve a significantly large amount of savings by changing its contract for printing from Rolls Printing to Printing and Supplies R US. Although the recommended organization is a smaller printing company, it will give the hospital an opportunity to achieve significant savings.
Currently, there are many incidents of over and under ordering of supplies at the Summer Bay Hospital. For instance, the committee has noted that it is a common phenomenon for a number of staff to order too many of 1 particular form and not enough of another. This may also contribute to wastage as forms need to be updated and excess forms shall go to waste, leading to an increase in the rate of wasting precious resources of the institution. To solve the problem, the committee recommends Summer Bay Hospital to introduce inventory control with regards to the ordering of supplies. This will reduce the cost and wastage by setting a minimum threshold in place for every item before it is ordered.
An important issue the committee has identified at the hospital is that there are no clear patient pathways, which means that there are many pages of progress notes being put into each medical record. For new patients, medical records are being set up with a certain number of each page. For example, 10 progress note pages are put into each record. This leads to an accumulation of excess pages that are never used, resulting into wastage of paper and loss of money.
To solve this problem, it is recommended that the hospital develop clear patient pathways that can be placed into a patient’s medical record depending on their individual needs. This allows departments to know how long a patient is likely to stay in hospital. Therefore, they are able to avoid putting unnecessary items into the patient records. Things can be added when there is a variance. In case of such things as progress notes, the items can be kept with the ward clerk or nurse stations and be assessed based on individual patient needs.
The Health Information Advisory Committee has also noticed that patient identification labels are affixed to many blank forms when the record is made. This means that many blank pages tend to go to waste in many medical records because not all patients need all the forms and/or other blank pages. It is recommended that the Summer Bay Hospital initiate a process of keeping PID labels in the medical record. In addition, most of the other less used forms should be kept at the nurses’ station and be put into the medical record when they are required. The wastage aspect shall be discussed in a later section.
During its research, the Health Information Advisory Committee has further noticed that there are many different forms being used for the same purpose. For example, the emergency department, outpatients department and general admissions tend to have different observations forms. This means that the hospital is currently ordering three different types of observation forms at different prices. Similarly, all investigation departments such as endoscopy, radiology and pathology use different forms, which are a great cost to the hospital.
The solution proposed by the committee recommends the hospital to redesign some medical record forms that vary across departments and amalgamate them to create a single form that meets the needs of all the users. Furthermore, we suggest that the institution amalgamate different forms within the medical record with similar functions to ensure that it reduces the number of forms in the medical record. For example, it is important to combine the allergy and warning page with the general information page. It is expected that this strategy will reduce the number of pages but put all this important yet similar information in one place for clinicians to access.
The problem of wastage and recommendation for improvement
At the current stage, the Summer Bay Hospital is printing many sheets of patient identification labels to insert into a plastic pocket in the front of the medical record. This ensures that they are readily available when needed. However, this practice causes a lot of wastage since not all of the records are being used. To reduce this type of wastage, the committee recommends the hospital to print the labels only when needed. This will also allow the institution to save money since the costs of the labels are quite expensive.
Currently, the hospital is purchasing cheap, non-sturdy clips for the medical records. These clips tend to break when the size of the medical record increases with time. At this stage, about two clips are breaking per medical record. This increases the cost because the institution needs to buy more clips quite often, leading to wastage because the broken ones are always thrown away. Therefore, the committee has recommended the hospital to start buying more durable clips. It has been noted that the durable clips, though expensive, will reduce waste.
The plastic pockets at the front of the medical records used to store patient identification labels are constantly breaking. Therefore, the institution needs to replace them. This means that there is a lot of wastage in the current system. To reduce the wastage of plastic pockets, the committee recommends the hospital to hole-punch the patient identification label stickers and completely get rid of the plastic pockets. However, by doing this, a small margin need to be printed onto the patient label page to allow enough room for the hole-punch without ruining any of the patient labels.
The Health Information Advisory Committee has also identified that some pages within the medical records are used much more regularly than others. Therefore, they need to be replaced due to their tendency to rip around the binder holes. Discharge summaries, in particular, need more regular replacements than other pages. Replacing them is becoming a significant cost to the hospital. This is also common in patients with a high return rate such as chronically ill and the elderly people. The same issue occurs in the medical record covers for the high risk patients.
To solve this problem, the committee recommends the hospital to implement plastic reinforced binder pages for patients with a high return rate as well as on pages such as the discharge summary. The committee expected the extra cost incurred on the short-term basis to reduce the overall costs and wastage in the long term. Similarly, implementing plastic reinforced medical record covers for patients with a high return rate or chronically ill will reduce costs and wastage significantly.
Finally patients with chronic conditions will require slightly higher quality materials than others. Since their medical records contain a lot of extra information, it is recommended that the Summer Bay Hospital buy high quality paper clips and other items to ensure that no information is lost due to a reduction in quality.