A study to Ascertain the Misuse/Wastage of

Medical Record Forms at a Tertiary Super-

Speciality Hospital

Journal of the Academy of Hospital Administration

Author(s): Anupam Chattoraj, S Satpathy, R K Sarma
Vol. 16, No. 2 (2004-07 – 2004-12)

Presented By……

Dr SANTOSH S. PATTAR
FIRST YEAR MHA
J.N.M.C. Belgaum
Key Messages:

•A sizeable number of printed forms are misused or wasted in hospitals. It is

possible to calculate wastage/misuse by scientific methods.

•Measures should be taken to reduce wastage of forms by increasing awareness

of staff, printing the cost of form in one corner and providing plain paper for
rough work.
ABSTRACT

The tertiary level super Speciality hospital earmarks approximately 0.7 to

0.8% of the budget for consumables (Non Plan) for printing of forms.
A prospective study was carried out in the months of March, April and May
2004 over a period of three months with the aim of making an attempt to
find out the possible wastage of medical record forms in various areas of the
hospital.

The stock of selected medical record forms in the study areas were
ascertained before the beginning of the study. The number of forms issued
during the study period to the study areas was accounted for.

The difference between the sum of the opening stock and issue quantity and
balance stock gave the apparent consumption of the forms.

The difference between the apparent consumption and actual consumption

would be the wastage/ misuse of the forms.

The results showed that a sizeable number of forms are misused or wasted.
 INTRODUCTION

•Historically, medical records have been a chronological assembly of facts, in the

form of notes, forms, reports and summaries.

•The printed form is a tool with a message or job to do. It is the physical carrier
of data-of information.

•They are the vehicles for most communications and the blueprint, for,
eventually, every activity.

•This is based on the principle that "people forget, but records remember".

•The basic set of forms in the hospital include the Front/Face Sheet, consent for
treatment, correspondence and legal documents received about the patient,
discharge summary, admission and progress notes, nursing notes, operation notes,
consultations, pathology and other reports and medication charts.
 OBJECTIVE

To find out the possible wastage of medical record forms in various

areas of the hospital.
 MATERIALS

Around 180 types of printed forms are used for various patient care activities at
AIIMS Hospital. These forms can be classified under the following broad categories:

•Forms used for patient care

•Core forms (basic medical record forms)
•Diagnostic forms
•Department (discipline) specific forms
•Forms for Administrative purposes

The study sample comprised of all the core forms of the medical records
department, and 10% of the other categories of forms, selected by stratified random
sampling. Thus, a representative sample of Diagnostic, Department Specific and
Administrative forms selected by random number technique were included in the
study. In addition, the OPD card was also selected.
During the prospective study, effort was made to correlate the consumption of
commonly used forms with the OPD attendance and in patient admissions in the
representative areas.

• One Medical Ward (C-2),

• One Surgical Ward (C-7),
• One super specialty (Urology) ward (C-4)
• One Emergency ward (C-6)
were selected in these four wards and considered to be 'representative' of the
hospital patients.

These wards were chosen as they represented a complete spectrum in the form
of an acute medical and an acute surgical ward, a highly specialised ward and an
emergency ward where patients are admitted under all specialities.
METHODOLOGY

The following methodology was adopted for the study:

1.The stock of selected medical record forms in the study areas were
counted at the beginning of the study. This was the opening stock.

2.The quantity of same forms issued during the study period was
ascertained from the hospital stationery stores records.

3.Balance stock of the forms was counted at the end of the study in
these areas.

4.The difference between the sum of the opening stock and issue
quantity and the balance stock at the end of the study period gave the
apparent consumption of the forms.
5.A study of sample case sheets of indoor patients in the study areas as well
as in the Medical Records Section was undertaken to find out the
approximate average number of each of these forms used per indoor patient
document.
6.Outpatient attendance and the number of inpatient admissions during the
months of March 2004 – May 2004 were ascertained from the medical
records department.
7.The average number of each of these forms per inpatient and outpatient
record were multiplied with the total number of admissions and outpatient
attendance respectively during the study period. The figures arrived at was
assumed to be the actual consumption of each of these forms.
8.The difference between the actual consumption and the apparent
consumption was assumed to be the wastage/ misuse for each form.
9.This wastage was expressed as a percentage for comparison purposes.
 RESULTS

Forms are being frequently used for purposes other than for keeping medical records.

The Consultation Record forms, meant for use by physicians is used for a variety of
purposes like writing complaints, sending requisitions to stores etc.

Forms were not kept in the racks meant for them. Considerable time and effort had to be
spent to locate a particular form during the survey.

Clinicians, being pressed for time, used to pick up any type of form readily available
even though the particular form was not meant for that particular purpose.

Because the forms are kept together in the pad with an adhesive, often more than one
form are detached when the doctor tries to remove one. These are then tagged to the
case sheet irrespective of their utilization subsequently.
Table 1: Apparent consumption, actual consumption, wastage/ misuse of different forms
Stock before Issue during 3 Balance Stock at Apparent Actual Wastage/ %
Form Title
Study months end of Study Consumption Consumption Misuse Wastage

Diet Slip 2600 200 2150 650 360 290 44.6%

General History &

1500 8200 400 9300 8000 1300 16.25%
Physical Exam

Blood requisition slip 2250 3700 3800 2150 1800 350 16%

Consultation Record 1950 Nil 700 1250 1110 140 11.2%

Fitness Certificate 950 300 1000 250 225 25 10%

Discharge Summary 4250 500 2600 2150 1950 200 9.30%

Admission slip 900 2300 1400 1800 1700 100 5.55%

OPD card 9295 1,52,050 4115 1,57,230 1,50,000 7030 4.47%

Progress Report 1300 7300 1300 7300 7000 300 4.11%

Nurses Notes 2200 8100 1500 8800 8500 300 3.40%

Bacteriology form 3100 5000 2650 5450 5350 100 1.83%

Consent Form 2130 200 1450 880 875 5 0.5%

 CONCLUSION

•A sizeable number of hospital forms are misused or wasted

because of various reasons ranging from lack of awareness among
users as to their purpose and cost, lack of supervision in wards, to
non availability of plain paper for rough work.
RECCOMMONDATION
•Ensure effective and efficient utilization of medical record - forms, it is
imperative that all efforts are made to reduce misuse / wastage of printed
stationery.

•Measures should be taken to reduce wastage of forms by increasing awareness

of staff.

•Printing the cost of form in one corner

•Providing plain paper for rough work.

•Computerized patient records management in an overall integrated hospital

management problems can solve many of the logistical problems associated with
paper based medical records.
REFERENCES

1.Huffman EK, Manual For Medical Record Librarians, Physician's Record

Company, USA, 1960, 1.
2.US News and World report, June 20, 1977, 48.
3.Elias M Awad, Richard D Irwin, 'Systems Analysis and Design', Homewood,
Illinois, 1979, 209.
4.American Hospital Association, Medical Records Forms For Hospitals, Guide To
Preparation,1972, 32.
5.WHO Medical Records Manual - A Guide For Developing Countries, AITBS
Publishers, 2004'.9
6.Medical Records Keeping, Do's and donts'- Express Healthcare Management.31st
March 2002.
7.Centre for Developing of Advanced Computing (CDAC) Hospital Information
System