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Management 1 Notes
Management 1 Notes
If the medical records department is not staffed 24 hours a day, it should be located
within easy walking distance from the admitting or out-patient area to ensure
hospital staffs are able to retrieve medical records on an emergency basis. Security
surveillance for safeguard of medical records information and equipment when the
department is closed should also be considered.
Space requirement
Space allocation should be determined by the departmental services to be provided,
the equipment and computer systems to be used and the daily workload to be
handled. Although services vary somewhat from hospital to hospital, services and
tasks to be considered when allocating space include record filing cabins, coding
and indexing desk, medical records sorting and arranging desk, outpatient
registration area, and admitting and discharge office.
The medical record service requires adequate space, which is generally not available
and presents a universal problem. Therefore, the medical records technician should
review space requirements frequently to overcome the highly common filing
problems in medical records department.
The medical records technician should anticipate in advance the growth of MRD
and make arrangements for the future requirements and to procure the required
space.
Equipment requirement
Open-shelf filing units are the most commonly used storage system for medical
records. They are less expensive. Medical records assistant can file or retrieve
records faster. Most importantly open shelves are space savers, accommodates more
records in a given floor area. Open-shelf filing equipment may consists of 7 or 10
shelves with a height of 9 to 10 ½ feet depending upon the NO. of shelves (Fig.3.2). 7
open shelves having 3 feet long and 1 feet width each with dividers can house an
average of 750 outpatient records in one compartment, thus housing 5250 records in
a single open-shelf filing unit. If a unit-numbering system is used, adequate shelf
space must be provided for growth of records as a result of readmission and repeat
clinic visits.
A review of records from the past several years is the best source of information for
working estimates of the amount of space required. One approach is to tabulate the
average number of sheets per medical record of repeat clinic visit and discharged
patient over two or three months. This can be achieved by counting the sheets per
current episode of care and the sheets for previous episodes of inpatient or
outpatient care. This tabulation indicates the size of an average medical record for
the hospital.
Climbing devices
Open shelf filing unit is designed to reach the maximum height of medical records
filing room in order to save the space available. When medical records are placed at
more than the height of 5 feet or 6 feet, it may be difficult to retrieve them. Hence,
hospitals use various types of climbing devices to reach the medical records kept at
a height of up to 8 or 9 feet.
An aluminum ladder with rubber bush at the bottom of the leg or a step type ladder
will be of greater use to the retriever to file or retrieve the records easily. Aluminum
ladder will be less in weight and easy to carry inside the medical records room. The
rubber bush avoids ladder from slipping down.
The step type steel ladder will be easy to climb exclusively for female (Fig.3.3). Thus,
climbing device will be much more helpful for the filing assistants to place or to
retrieve medical records much quickly avoiding unnecessary accidents.
Organizational chart
It is important that each employee knows the limits of his authority and
responsibility, and an organizational chart is a good means of informing others
about such relationships. An organizational chart indicating the functions and lines
of authority should be clearly established (Fig.3.4). This will ensure there is no
ambiguity in understanding either the line of authority or the duties and
responsibilities of staff members. In a medical records department procedures may
be written for every job performed.
Job description
Written procedure manual for job description provides a valuable tool for two
reasons.
Routine tasks
With thorough knowledge of the work involved and with occasional supervision of
the medical records Technician, uses initiative and independent judgment in the
departmental activities.
Prime job
To ensure smooth functioning in the New and Revisit Registration area, Admission
and Discharge area and medical records department
To ensure quick disposal of patients from the Registration, Admission and discharge
areas
To meet the training requirements of the new medical records staff and trainees
To ensure that medical records codification is updated by clinic wise and surgical
wise everyday
To prepare monthly and yearly Statistical reports
Role and responsibility
To update codification of medical records by diagnosis wise and surgery wise
everyday
To prepare statistical report according to surgery wise and doctor’s wise everyday
To ensure that medical records are processed serially and filed everyday
To generate all statistical data on daily, monthly and yearly basis to submit to
Management authorities
To take regular classes for the medical record trainees based on the medical records
book
To procure and keep all forms and stationary needed for every week from stores
To solve problems and grievances (if any) of patients and to ensure patient
satisfaction
To ensure that medical records are inactivated and disposed of based on the
inactivating and disposing policy of the hospital
To ensure that adequate space and racks are available to keep medical records every
month
To ensure that missing medical records or wrongly filed medical records are
searched and taken out
Working relations with other department
To co-operate with accounts section on day to day handling of registration,
Admission and lab investigation cash and settlement of accounts
To coordinate with computer section in generation of any statistical reports required
by the management and in case of any computer problems
To coordinate with the doctor’s secretary in issuing medical records to doctors for
project study and seminars
The new staff member should first be introduced to all the personnel of the
department and later to the hospital’s important units, which maintain a close
relationship with the medical record department. In the initial training stage, staff
members should be placed under an experienced medical records supervisor who in
turn must impart “on job training” and instruct the new staff in observing the
correct policies and procedures.
Evaluate performance
Every staff wants to know where he stands with his/her supervisor.
Evaluations of performance should take place on a regular basis. Point out to the
staff his/her strengths and weakness.
The medical records technician should assist the staff in correcting poor
performance. The medical records technician and the supervisor should share in a
process of goal setting. This provides a staff with direction for development and
creates job satisfaction and improves his/her self-confidence. Verbally scolding a
staff in presence of others is not acceptable.
Supervisors should strive to maintain two way communications with staff, and
staffs should be encouraged to make suggestions.Supervisors in turn should be
sympathetic when listening to staff’s problems. Finally, a supervisor will at times
have to give priority to get a job done by the staff or to untie a problem.
Main Functions
The main functions of medical records department are
Out-patient service
Registration of new and revisit patients
Guiding patient to units and specialties
Coding of out-patient and in-patient medical records
Collecting, processing, sorting and arranging of medical records
In-patient service
Admitting patients
Discharging patients
Out-patient service
The purpose of the out-patient service area is to register new and revisit patients
and direct them to the concerned units or specialties for consultation and treatment.
Collection of medical records from the out-patient clinics, speciality clinics and
discharge counter
Checking for deficiencies in outpatient and inpatient records
Coding of completed records in the system
Sorting and serially arranging medical records
Admission counter
This admission counter functions 24 hours a day throughout the year. Staff are
posted in two shifts (morning and night) to perform the following functions.
The patients are guided by the counselors to the admission counter after counseling
is done for the type of lens and room they prefer.
The admission counter staff collects the money for the surgery and an advance
receipt is generated in the system.
The receipt is signed by the staff and handed over to the patient.
The inpatient record is prepared with patient name, age, sex and a rubber stamp is
stamped to write the type of lens and the amount paid by the patient.
Signature of the patient or his attendant is obtained in the operation consent form.
A color folder is attached to hold all the relevant medical record forms of the patient.
This folder denotes the speciality to which the patient is admitted.
Patient is then taken to the ward or theatre by the nursing staff along with the case
sheet for surgery.
In-patient coding assistant
After surgery is performed in the theatre, the medical records are sent to the
inpatient coding assistant.
Each medical record is coded for the surgery performed in the theatre, which
automatically updates the charges for the surgery in the system.
If patient is supported by monitor or any other additional procedure is done during
the course of the surgery, they are also charged and updated in the system.
Discharge counter
The case sheet is received from the ward through the nursing staff to the discharge
counter
The final receipt is generated according to the number of days stay and for the
surgery performed
The final receipt along with the discharge summary is handed over to the patient
The follow-up date of patient’s revisit is explained to the patient by the discharge
counter staff
Departmental meetings
There should be weekly general meeting with all departmental staff to review the
day-to-day work carried out by the medical records department. Any new
innovations brought for the better improvement of the department can be shared
with the staff members. The problems and issues related to the staff and the
department can be discussed among the staff with the medical records technician
and proper solution should be evolved for the smooth functioning of the
department.
Summary
The medical records department staff must be more than a skilled technician.
He/She must be both a leader and an innovator in building up a well-organized,
efficient department. Constant effort is necessary to keep abreast of the advances in
both medicine and the technology of recording and retrieving data. Efficient
organization and management of the medical record department are important
factors in the accreditation of health care facilities. The health facility exists for the
benefit of the patient, and its medical records department is responsible for the
accuracy, safekeeping, and availability of the medical record at all times. It can
discharge these responsibilities only when it is properly organized and well
managed by the medical records assistant.