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Problem Lists - What is Required?

Accreditation Monthly, September 15, 2009

When on-site assessing ambulatory care for standard compliance, I am often asked about what is required for a problem list (now called summary lists).

The intent of the summary list is to provide a quick reference of needed critical information about a patient in order to provide optimal and safe care. Many patients travel from clinic to clinic or provider to provider, and if the critical information is not easily available, it may be missed when making decisions about care and treatment. The list generally includes:

• Newly identified and chronic diagnoses
• Procedures performed
• Allergies and drug interactions
• Medications taken (medication reconciliation)

When Required
A summary list must be initiated anywhere in the ambulatory setting by the third visit. Each clinic provider would then update the list as necessary.

When not Required
According to the Joint Commission FAQ dated August 5, 2009, "A summary list is not required in settings where patients present with a known diagnosis and receive one-time predetermined care (e.g., ambulatory surgery, diagnostic imaging services)."

Process
Hospitals with multiple ambulatory care settings should decide who is responsible for initiating the summary list and how the lists will be made available to providers as needed. I have seen both manual and computerized summary lists.

The Joint Commission also cautions, "…should the organization allow each outpatient setting to initiate and maintain its own summary list, the organization increases the risk of not having the most current patient information available to each area."

This is a challenging process for ambulatory care settings where each clinic maintains its own record for patients with multiple visits, such as wound clinic, pain clinic, and physical therapy. In these circumstances, there needs to be a centralized summary list that can be accessed at each visit and updated as needed.

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