Implementing a New Chart Order in an Acute Care Hospital: One Center’s Experience
This presentation has provided readers with some of the important elements when considering the implementation of a new chart order. Now let's compare this with what actually happened at the hospital…..
Decision to make the change:
a. Based on inconsistencies in the manner in which patient information was filed on different units
b. Created inefficiencies and frustration for health care professionals when they tried to find the information on different units
c. Unsafe for patients, particularly in an emergency situation where timely access to crucial information is important
d. Medical records staff had to sort through the charts after patient discharges to arrange the information in order
Identification of stakeholders:
a. Health care professionals documenting in patient charts (nurses, physicians and allied health professionals)
b. Unit clerks who have to dismantle a chart when a patient is transferred out and re-organize the chart when a patient is transferred into a unit
c. Senior administration who is ultimately responsible for all aspects of patient care
Decision on the new chart order:
a. Came about after multiple complaints from health care professionals about inconsistencies in patient charts
Empowering a key department:
a. The manager of Medical Records was identified as the lead on this project and was given complete support from administration
b. Medical Records staff were identified as resources and trainers for the project
c. The chief operating officer (COO) met with the medical records staff and they collaboratively produced a one-page document outlining the contents of a “new chart order”
Communicating the change:
a. Memo(s): institute-wide, announcing a new initiative and a “go-live” date; announcing training dates for unit clerks; announcing the process on the “go-live” day
b. Meetings: discussed at leadership meetings (e.g. unit supervisors with program managers) and at unit level staff meetings (e.g. frontline staff with unit supervisors)
c. Intranet: announced on the internal website
d. Newsletter: announced in the hospital newsletter
Staff training:
a. Medical records staff trained unit clerks in all areas
b. Coverage was provided to offset unit clerks having to leave the unit
c. Each unit clerk was provided with a contact name and phone number of a resource individual
Implementation:
a. In the days leading up to the go-live date, e-mails and memos were sent out as reminders
b. New, empty chartbinders were brought to the units and information was transferred from the old charts to the new charts
c. Extra unit clerks were brought in to assist with this task to minimize disruption on the units
Evaluation:
a. All staff was encouraged to share concerns with lead individuals in the Medical Records department. When possible, concerns received an immediate response. The COO personally responded to questions that were referred to her by the medical records staff.
b. Based on feedback, some aspects of the chart order were modified.
c. Implementation was considered successful and although this was a major change for the organization, it was adopted very quickly and smoothly.
Decision to make the change:
a. Based on inconsistencies in the manner in which patient information was filed on different units
b. Created inefficiencies and frustration for health care professionals when they tried to find the information on different units
c. Unsafe for patients, particularly in an emergency situation where timely access to crucial information is important
d. Medical records staff had to sort through the charts after patient discharges to arrange the information in order
Identification of stakeholders:
a. Health care professionals documenting in patient charts (nurses, physicians and allied health professionals)
b. Unit clerks who have to dismantle a chart when a patient is transferred out and re-organize the chart when a patient is transferred into a unit
c. Senior administration who is ultimately responsible for all aspects of patient care
Decision on the new chart order:
a. Came about after multiple complaints from health care professionals about inconsistencies in patient charts
Empowering a key department:
a. The manager of Medical Records was identified as the lead on this project and was given complete support from administration
b. Medical Records staff were identified as resources and trainers for the project
c. The chief operating officer (COO) met with the medical records staff and they collaboratively produced a one-page document outlining the contents of a “new chart order”
Communicating the change:
a. Memo(s): institute-wide, announcing a new initiative and a “go-live” date; announcing training dates for unit clerks; announcing the process on the “go-live” day
b. Meetings: discussed at leadership meetings (e.g. unit supervisors with program managers) and at unit level staff meetings (e.g. frontline staff with unit supervisors)
c. Intranet: announced on the internal website
d. Newsletter: announced in the hospital newsletter
Staff training:
a. Medical records staff trained unit clerks in all areas
b. Coverage was provided to offset unit clerks having to leave the unit
c. Each unit clerk was provided with a contact name and phone number of a resource individual
Implementation:
a. In the days leading up to the go-live date, e-mails and memos were sent out as reminders
b. New, empty chartbinders were brought to the units and information was transferred from the old charts to the new charts
c. Extra unit clerks were brought in to assist with this task to minimize disruption on the units
Evaluation:
a. All staff was encouraged to share concerns with lead individuals in the Medical Records department. When possible, concerns received an immediate response. The COO personally responded to questions that were referred to her by the medical records staff.
b. Based on feedback, some aspects of the chart order were modified.
c. Implementation was considered successful and although this was a major change for the organization, it was adopted very quickly and smoothly.
