On news reports - is there a reason why hospital notes go missing so often?

[PinkBottleGreenBottle]

I don't have any personal experience of this. But I was listening to the news this morning, an investigation over medical treatment that had gone badly wrong, and once again when they went to look back, the hospital records had gone missing. It struck me that nearly always seems to be the case in most reports of this kind that I hear. I'm sure I've also seen threads on here where something has happened in hospital that can't be properly looked into because the records have are missing, or occasionally have been destroyed in error.

Is this a known issue? Is there a particular reason for it? For example, I know that a while ago there was a disastrous attempt at centralising medical notes, so maybe there are database problems? But if they go missing at these times, then presumably they go missing at other times as well... as I said, I have no experience. I just wondered if someone else had more insight into it.

Destroyed in Error? when there is an ongoing investigation that could get a person sacked or make the hospital pay out in compensation oh yes I believe that happens - however I also believe in Santa Claus and the tooth fairy.
Arse covering springs to mind in cases like that

I think that there are thousands and thousands of files (millions, even?) and if a file is put away in the wrong place, even one place out, then it is gone for good. It is the same in very big libraries.
Maybe soon they will be able to put a tracker on the files, as one can with cars, which will make it possible to find them.

In these circumstances, yes, there's a reason. It's called 'ohshitwe'vereallyfuckeduplet'shidetheevidence'. Happens an awful lot.

I think often it's bits of records that go missing, charts and the like. As records increasingly go online though it will reduce massively.

I've been involved with this area of health care for a long time now.

There are a huge number of people who add documents to a paper medical record. Some times staff don't record things that they should record which can then result in a 'missing record'.

Other times, the whole file can be misplaced, misfiled, not tracked correctly (eg handed from one staff member to another without the tracking record being updated to reflect that move) or taken away from an office, clinic by a clinician withouth telling anyone.

It is still not uncommon for consultants to take records home in the boot of their car without the permission to do so and without telling anyone that they've taken the record.

Medical record libraries in big hospitals can be huge (they will reduce as more and more records are created electronically). Misfiles happen

I have been working in medical record and related fields for a long time and I have never heard of records being 'lost' on purpose. I have known cases where certain documents haven't been filled in correctly or filed at the appropriate time and have, unsurprisingly, then gone missing.

sorrel, all that is undoubtedly true. But it's amazing how often records that clearly did exist and were available initially are 'lost' when someone makes an official complaint or contacts a solicitor. You and your colleagues in medical records may be entirely efficient and blameless, doesn't mean there aren't other people who make sure records aren't available when the lawyers come calling because someone has been killed or injured.

Ordinarily missing notes: mine had disappeared when I had to go back to the consultant team who'd originally looked after me with a serious chronic condition. I was fine for years, then it flared up again and I was referred back to the hospital. They'd lost almost all my notes; they managed to find a few bits of paper but couldn't trace pretty important stuff, like my original brain scans.

Probably didn't help that several people who clearly weren't paying attention had mis-spelled my name in several different ways on different pieces of paper over the years. It's quite important when you are dealing with patients to spell the darn name right so Mrs Anne Jenkins doesn't get the medicine or surgery or other treatment/diagnostic process intended for Mrs Anna Jenkinson. (And this particular hospital had managed to carry out a hysterectomy on the wrong patient not long beforehand.)

• Several months later they'd managed to cobble together a few more of my original notes. But still not everything.

Actually I'd forgotten when writing that post, I once did a story (am a hack) with a whistleblowing medical secretary at the same trust. Poor woman had been bullied and harassed and driven nearly mad for pointing out that a backlog of 3,000 unreported diagnostics - X-rays, scans and so on - was a bit of a problem.

My title and the Evening Standard did a series of stories on it, but the senior consultants and managers mostly got away with it - I think one person retired early. The whistleblowers (inc. a consultant) were very damaged - their careers suffered terribly but also their mental health.

Many of the patients affected, especially children, will have suffered avoidable harm as a result. Some of them will never know what caused health problems they have yet to develop.

A well known TV doctor worked at this trust and rang me up to harangue me for daring to write about the story because it was unfair to the trust and unfair to his senior consultant mate who was in charge of the incompetent department. Always makes me want to punch the screen when I see the self-satisfied jerk who was more bothered about the medical hierarchy and protecting his mates than patients potentially dying or suffering harm.

Oh I wish I knew which TV doctor that was, they don't deserve to be on TV if that is how they behave.

edam. It's absolutely unacceptable that things like that happen but sadly they do. At most hospitals it is made very clear that filing into the case note folder is everyone's responsibility. Sadly, due to a lack of admin time/support on the wards, notes often get sent on to the next location with lots of loose filing tucked inside the front cover.

A full electronic record can't come quick enough as far as I'm concerned. Paper records have had their day. These days there is too much information that needs to be recorded to effectively maintain the current system.

The increasing use of the NHS number as a unique identifier is starting to reduce the amount of double registrations, assigning records to the wrong patient type errors. The sharing of records between health care providers is the next hurdle. Many patients want this to happen (and can't believe that it doesn't already) but equally many don't want their information to be shared.

Alas, I have worked with a few less than efficient records staff. They never seem to like my management style .

oldboots, I don't want to identify him as I'm sure he can afford good lawyers and I don't have all the notes from back then. But he is a VIP - not just a TV personality.

I do find it suspicious.

And yes my records went missing while I was in hospital once and it caused big problems. I didn't know, I was just parked in a bed very ill and assuming everything was fine whilst being missed off rounds etc!

I asked to see the notes a few years later and it was just a single page with a paragraph about my emergency surgery. My GP who was looking at it with ne said that wasn't unusual.

I nearly died due to misdiagnosis after my A&E notes were lost, but no, funnily enough, no record of that.

Big old to that.

I'm not saying that some slightly odd things may have or may still be going on (I hope not) but IME, missing notes (i.e. the actual file is not where it should be as opposed to missing entries in the notes) are usually down to a complete lack of following the laid down admin procedures.

For example, a patient is admitted to a ward via A&E. The notes should be requested from Medical Records at the time of the decision to admit. If that is at 02:30, there may be no one available to retrieve the notes from the records library (or another location around the hospital if the patient is already being seen by other clinicians). The next day, the ward clerk should chase up the request but in the interim the patient may have moved wards again so they don't bother. The ward clerk on ward B re-requests the notes to be told that they are in transit to ward A. They go to ward A to get the notes but in the meantime, a member of the clinical team treating the patient has spotted the notes on the trolley and taken them for review on ward B. So, you now have a set of notes which are traced to one location but are actually with a Dr who may have taken them to any number of offices or meeting rooms.

This is just one of a multitude of scenarios.

A couple of years ago, my manager (v senior director) had to attend a coroner's court hearing and answer questions about a set of notes which had gone missing in circumstances not unlike I've described above. She is a tough lady but found the experience terrifying. She wan't able to answer the questions as it's actually impossible for one person to account for over a million sets of records. As I said up thread, an electronic patient record is the only way to solve this once and for all. An EPR has a proper audit trail too.

Record keeping, the actual recording of information within the record is a complete minefield in itself and I don't think that HCPs are given enough training on this.

Yeah, I think it was just organisation that meant my original notes went missing between a&e and ward. But outside of surgery I spent the rest if my stay in that same ward, and presumably there should have been notes about the week I was there, but there is nothing but 1 basic page. That's what I find so odd.

I do agree electronic notes would improve things massively.

TeWiSavesTheDay I would hazard a guess that the paperwork just didn't get filed properly at the time you were discharged from the ward and then never caught up with the main folder.

It annoys me though. That disorganisation has done serious damage to my health, and no one even bothered to finish my file?

Bit off topic I guess. But I do think the lack of coordination over records has a massive impact on care and if we could fix it ...

In our local hospital notes are left on unlocked trollies in the corridors. It doesn't surprise me they go missing.

If maternity patients can be made responsible for their own notes, why can't at least some of the other patients?

I agree with everything you say. The trouble is that the cost of running a comprehensive proper records service is prohibitive.

I'm currently carying out a review of health records across a county wide community health service. I'm actually going to recommend that they archive the lot and then implement a proper destruction programme rather than spend money on trying to fix the unfixable. Invest the money in connectivity for HCPs working in the community etc so that people are tied to desk PCs and wired networks. Give HCPs tablets to use on the wards so that they can record info as they go rather than trying to type everything up at the end of each shft. I could go on and on about this.

I have lost count of the number of papers and plans I've presented to various boards and committees clearly outlining exactly what needs to happen to sort the situation but sadly, it's always too expensive to implement.

Darn money!

I get where you're coming from. Starting with a clean slate would be the most efficient thing at this point.

I'm sure it would save money to get it sorted too. Less cock-ups because of lost notes would mean less being sued to start with! Plus staff spending less time on paperwork.

Hope you make some progress soon.

Phineyj TBH I've only ever experience one incident of a set of notes actually being stolen from a trolley. But I guess if they were stolen very carefully, we'd never know! Joking aside though, if you see an unlocked trolley, report it to PALS. It's one of my personal bugbears and it's sloppy practice.

Unfortunately, the hand-held record (e.g. Maternity) brings with it its own problems. Records are frequently lost by the patient or the patient fails to bring them to appointments etc. resulting in the need for a temporary set to be created. Some patients have multiple volumes of notes. There is no way that a patient could manage to transport them back and forwards all the time. The NHS struggles with it!

We just need to be brave and get rid of the paper, now!

Interestingly, one of the biggest barriers to adoption of EPRs is patient worry about data securiy, loss, sharing etc. Honestly, it couldn't be any worse than it is now.

TeWiSavesTheDay

It basically boils down to needing more admin staff to manage the process for the HCPs so that they can concentrate on the patient. Unfortunately recruitment of admin staff is a very unpopular with the general public!

To give you some idea of costs, imagine a records library with over 500,000 loose pieces of filing sitting there, waiting to be filed. This paper should have been filed at discharge/patient contact by clinic/ward staff or med secs. It wasn't (for a myriad of reasons) and has by default ended up back at the records library. Unfortunately, the library isn't resourced to carry out filing. It only has enough staff to retrieve notes for clinics and admissions and then re-file them. The staff work to very rigid daily targets so there is no wriggle room to spare on other tasks. Repeat this across many, many hospitals. It's awful, frustrating and wrong.

Very frustrating. Do you think it will change soon, or ever?

It's interesting how the barriers you've talked about are worries about things that might happen (but are already happening anyway) and how the public might react (that's what spin's for!) as opposed to solid facts.

That would wind me up intensely in your position!

I try not to let it but it's immensly frustrating. TBH I took the coward's way out and left permanent NHS employment to work as a consultant on problems like this. It means I can be quite blunt with my recommendations and proposals and not worry so much about upsetting people. Believe me, one stubborn person can easily scupper an IT project!

It is changing. Nearly all trusts are in the process of implementing electronic solutions but it's a long and expensive process involving huge changes of culture and working practice.

Sorrel, electronic records have hardly been an astounding success, have they? Look at the programme that has been called loads of things but the main one I recall is NPFIT - that was all about creating an electronic record for everyone. Enormously expensive, enormously complicated, enormous failure... Largely IIRC because ministers, bless them, were dazzled by all that shiny IT stuff and the civil servants didn't know or didn't have enough information to specify what they wanted, and companies ended up walking away. With vast amounts of public money...

(I remember the claims that it was all going to be jolly secure, yet when it actually happened for real, staff in A&E were leaving their supposed secure identifiable keycards in the computer all day, so everyone was using the same ID and anyone walking past could have found out about Mrs Adam's gall bladder or Mr William's prostate...)

I'm sounding like a right grumpy old woman, sorry.