May | 2013 | | Page 2

I know that the most frequently viewed post(s) on this blog are regarding Medical Record Review (MMR) using the Joint Commission International (JCI) Accreditation Hospital Standards.

This post is also regarding Medical Record Review. I shall be using ‘Medical Record Review’ rather than ‘Medical Records Review’ from now on to reflect what JCI uses in its manual. I guess this is no big deal, but I shall conform.

I have been using the term MMR Tool (MMRT) but do take note that the MMRT is also referred to as the Medical Record Review Form (MMRF) as in the JCI’s Hospital Survey Process Guide (HSPG).

This post is about the MMRT / MMRF as recommended in the JCI’s HSPG, 4th Edition, Version 2 effective 1 January 2011. All future posts related to the application of the MMRT / MMRF will be based on this latest edition of the JCI’s HSPG.

I have been posting posts related to the application of the MMRT / MMRF (you can view this particular tool /form from this link which will open in a new tab of your current window) as recommended in the JCI’s HSPG, 3rd Edition, effective January 2008.

You can view a sample of the latest MMRT / MMRF from this link, which will open in a new tab of your current window.

The purpose of using the MMRT / MMRF according to JCI (HSPG, 4th edn, p. 70) remains as before, that is to help “validate the hospital’s compliance with the documentation track record”, i.e to also say in JCI’s words (HSPG, 4th edn, p.70) that is “to gather and document compliance with standards that require documentation in the patient’s record”.

Health Information Management (HIM) / Medical Records (MR) practitioners need to know that the MMRT / MMRF is used during closed patient medical record review session(s) in addition to during tracer activities when the same MMRT / MMRF is used during open patient medical record review session(s) using ‘open’ medical records of patients currently staying in the hospital are evaluated.

While I understand that the survey team will provide the latest version of the MMRT / MMRF which will include any approved changes in the standards, an HIM /MR practitioner or the hospital quality assurance (QA) department is usually required to provide the MMRT / MMRF for mock closed or open patient medical record review session(s).

You will notice that both the latest and previous versions of the MMRT / MMRF are organised as follows:

By three (3) topic headings, ‘Consent’, ‘Assessments’ and ‘Other’

Each topic heading includes several standards
Each standard under a topic heading lists the specific standard number e.g ‘ACC.3.2.1’ as listed under the topic heading ‘Other’
Each specific standard under a topic heading lists the standard requirement i.e the specific standard’s requirement as will be printed in the ‘Documentation Requirement’ column in the MMRT / MMRF, e.g the standard ACC.3.2.1 requirement is as printed below:

“Discharge summary contains the following:

- - Reason for admission, diagnoses, and comorbidities
  - Significant physical and other findings
  - Diagnostic and therapeutic procedures performed
  - Significant medications, including discharge medications
  - The patient’s condition/status at the time of discharge
  - Follow-up instructions”

During an accreditation survey, the surveyor(s) – be they be members of the real JCI accreditation surveyor or members of the hospital’s mock MMR process team, will both use the MMRT / MMRF :

to enter the number of the medical record being reviewed and the type of medical record requested (recorded by diagnosis) on the top of the form, e.g “Record #1234678 Asthma”)
to review the medical record according to JCI (HSPG, 4th edn, p. 70) so as “briefly to decide what type of patient or care was received (for example, surgery, medical, emergency, and rehabilitation).”

Another request (s) by the survey team or a typical MMR session by the hospital’s mock MMR process team can be read by reading my previous posts as follows (each of these links will open in a separate tab of your current window) :

References:

Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
Joint Commission International, 2010, Hospital Survey Process Guide (HSPG), 4th edn, JCI, USA
Joint Commission International, 2010, Hospital Survey Process Guide (HSPG), 3rd edn, JCI, USA

An article in the British Medical Journal (BMJ 2013;346;f1563) reported, “With more patients being treated but fewer beds, there’s no doubt that beds are being used more efficiently. But more intensive use could be a problem”.

The trend in fewer beds in use in hospitals can be seen in most countries in the Organisation for Economic Cooperation and Development (Fig 2).

Image credit: British Medical Journal (BMJ 2013;346;f1563)

In England this trend in the fewer number of hospital beds in use – by 59% for all beds since 1979 till 2012 can be viewed from Fig. 1, also shows sharp reduction in beds used for acute care, for maternity, geriatric care, mental illness and learning disability.This trend is the direct result of concerns (BMJ 2013;346;f1563) about “the need to save money and improve labour efficiency in the light of a shortage of nurses and general pressures on health service budgets.”

Since the number of beds in use has reduced but with increases in population, thus with more patients being treated but fewer beds, the time patients spend in hospital i.e the average length of stay (ALOS) a patient spends in hospital also needs to be reduced (shortened). John in (BMJ 2013;346;f1563) gives the example of ALOS for an acute case in England that “has shrunk from around 9.4 days in 1979 to about three days in 2011.”

John (BMJ 2013;346;f1563) adds some reasons in his article as he examined these trends and found new changes as follows that “have helped shift care from the ward to the outpatient department and beyond the walls of hospitals” :

medical practice
drugs
diagnostic procedures
policies which deliberately moved mental health, learning disability, and
geriatric services out of hospital and into the community

Image credit: British Medical Journal (BMJ 2013;346;f1563)

Fewer beds but more patients being treated means the daily bed occupancy (BOR) rises. For example, daily average BOR data across all hospitals for England reached over 90% on several days (Fig. 3). John (BMJ 2013;346;f1563) infers that “Such high occupancy rates reduce the time available for cleaning between patients and increase the chances of infection.”, although he believes and I believe too that “there’s no doubt that beds are being used more efficiently.”

References: