International Journal for Quality in Health Care Advance Access originally published online on July 2, 2009
International Journal for Quality in Health Care 2009 21(4):253-258; doi:10.1093/intqhc/mzp026
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Developing patient registration and medical records management system in Ethiopia
1 Johns Hopkins Medicine International, Johns Hopkins University, Baltimore, MD, USA
2 Public Health, Yale School of Medicine, New Haven, CT, USA
Quality problem. In low-income countries, medical record management is often lacking. We sought to evaluate the impact of an inexpensive business process re-engineering project on the accessibility and completeness of patient information and on physician satisfaction.
Design. Pre–post intervention study during 2006–07, using time-motion studies, medical record audits and physician surveys.
Setting. A rural hospital in Ethiopia.
Participants. Medical record personnel, hospital administrators, clinical staff.
Implementation. We implemented a hospital-wide patient registration and medical records re-engineering process, which included a simple, custom-made computer database to manage patient information, standardized medical records forms and processes and enhanced human resource management efforts.
Main Outcome Measure(s). We measured medical records accessibility and completeness, and physician satisfaction.
Evaluation. Medical record accessibility and completeness and physician satisfaction improved significantly (P < 0.05) based on pre- and post-intervention comparisons. The success rate of retrieving the proper medical record number for returning patients improved from 14 to 87% (P < 0.01); time to locate medical records decreased from 31.2 sec per record to 15.7 sec per record (P < 0.01); the percentage of complete medical records increased from 6.5 to 45.7% (P < 0.01). Physician satisfaction with the medical records system was significantly higher after the intervention (P = 0.02).
Lessons Learned. Our findings indicate that a well-organized medical record management system can be effective in improving patient information accessibility and completeness in hospitals in low-income countries despite the lack of resources. Longer follow-up is required to assess the sustainability of the hospital improvements accomplished.
Keywords: medical records, patient registration, quality improvement, business process re-engineering, Ethiopia, Africa
Address reprint requests to: Elizabeth H. Bradley, Public Health, Yale School of Medicine, PO Box 208034, 60 College Street, New Haven, CT 06520-8034, USA. Tel: 001-203-785-2937; Fax: 001-293-785-6287; E-mail: elizabeth.bradley{at}yale.edu
Accepted for publication May 25, 2009.