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Implement universal chart order to eliminate labor-intensive assembly

HIM Connection, August 31, 2004

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Mission: Reduce assembly and associated labor time
Goal: Save from 4-10 minutes for an average medical-surgical chart and up to 60 minutes for long-term rehab or skilled nursing facility records.

1. Assess the financial value of this alternative Sample cost comparisonCost comparison
   Average time to assemble the entire record......8 minutes
   Inserting loose documents in a universal chart..1 minute
   Average hourly rate of HIM analyst..................$11.00
   Average cost per minute................................$0.18

   Full assembly v. inserting loose documents into the chart: $1.47 v. $0.18

   Time Savings
   You save: 7 minutes per record
   20 discharges daily x 7 minutes = 607 hours per year
   (assuming 260 work days per year)

   
   
2. Host a universal meeting with clinicians
   Work with both HIM staff and clinical staff to inventory all forms and decide which should go behind each divider in the record. Assist patient-care support staff's filing efforts and add names or colors to the bottom of each form to match the color dividers. This guide helps new staff learn the order of the record and assists with the filing of loose materials that trickle into HIM after discharge.

   Keep in mind not all patient-care areas are the same. For example, an obstetrics patient does not need the forms a cardiac patient needs.

3. Use dividers that remain with the record
   By leaving the dividers in the chart, you can remove all material at one time. One-use dividers prevent disarray in the chart and can help all individuals who use the record until it is retired.

4. Remove the record from the chart at discharge
   Ideally, HIM staff remove the active record at discharge-a responsibility that maintains the integrity of the record order. Purchase and distribute additional chart backs (the notebooks used on the patient care floor to hold the patient record) to accommodate the delay of removing the record until HIM arrives.

   Retrieve discharges daily, seven days a week. Evening and overnight shifts are the best time because you will interfere less with caregivers. Complete the records for patients discharged earlier in the day after physicians' evening rounds. This time allows clinical staff to gather bedside documentation and insert it in the record.

   Since evenings are usually less busy for HIM departments, staff will have sufficient time to log the discharges into the HIM department, add loose documents, and prepare the records for coding and analysis.

This excerpt is adapted from the book More with Less: Best Practices for HIM Directors.

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