Application of lean management after audit of Medical Records Department in a COVID19 dedicated center during the COVID pandemic

Ruchi Garg; Yatin Talwar; Neeraj Garg

doi:10.1016/j.mjafi.2022.04.015

Application of lean management after audit of Medical Records Department in a COVID19 dedicated center during the COVID pandemic

Med J Armed Forces India. 2022 Jun 12;80(1):91-97. doi: 10.1016/j.mjafi.2022.04.015. Online ahead of print.

Authors

Ruchi Garg¹, Yatin Talwar², Neeraj Garg³

Affiliations

¹ Assistant Professor (Hospital Administration), AIIMS, Jodhpur, India.
² Resident (Hospital Administration), AIIMS, Jodhpur, India.
³ Associate Professor, Department of Hospital Administration, Armed Forces Medical College, Pune, India.

PMID: 35722445
PMCID: PMC9188669 (available on 2025-01-01)
DOI: 10.1016/j.mjafi.2022.04.015

Abstract

Background: The Medical Record (MR) contains the information which is needed to plan, provide, and evaluate the care given to the individual. It also serves as a pivotal tool for communicating information to all the health personnel who manage the patient, and it contributes to the continuity of patient care. There is an unmet need of identifying and correcting the issues faced with MR and Medical Records Departments (MRDs) so that higher efficiency can be achieved. This study was conducted to study the deficiencies and discrepancies found in MRD files during COVID management and to correlate the deficiencies with the facilities available and the workflow. Later Lean Management (LM) was applied to ensure compliance and efficiency in the system.

Methods: An observational study was done on the audit of COVID 19 patient files and facilities in the care centres. Process mapping was done. The data for LM were collected by brainstorming, observation, interview, and workflow review of several processes, values, number of wastes, and suggestions were documented the MRD staff.

Results: Area available was 400 m² which is adequate against the norm of 350 m². The existing staff of 30 was adequate as per norms. Deficiencies were observed in physical examination, history, radiology, and laboratory reports. The findings showed that the MRD units had 13 current processes, 26 wastes, and 10 values were identified. In addition, they were offered a total of 25 comments on eliminating the waste.

Conclusion: Staff and equipment were adequate. Recommendations include regular staff training and usage of electronic medical records, focus on deficiency check by specific MRD staff on regular basis monitored by the administration and supported by the medical audit committee. The study also recommends that suggestions applied after LM should be implemented in letter and spirit and a repeat study of LM is advisable after regular intervals to maintain the quality standards and to maintain or further improve the efficiency.

Keywords: Lean management; Medical audit; Medical record department; Medical records; Process improvement.