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Records Management and Data Quality - St Georges London

Two patients came to “severe harm” after their data was not completed properly at a teaching hospital.

St George’s University Healthcare Foundation Trust confirmed to HSJ this week that a clinical harm review had so far found two people who had experienced “severe harm”.

In a statement, the £600m turnover trust said the clinical harm group had so far carried out 104 patient assessments and found 92 cases of no harm and 10 cases of “low harm”.

The record keeping for elective treatment at St George’s has been investigated since last summer, when a consultancy firm found incomplete records for patients on the trust’s patient administration system.

This week the trust said it had cross-checked 2 million individual patient records.

In September, a trust spokesman said: “We are confident that, as we interrogate the data over the coming weeks and months, the number of patients actually affected will be far, far less than this. This has been the experience of other trusts.”

At the time of publication, it was not known what specialty the two patients who experienced sever harm were being treated in or how many patients remain to be assessed by the clinical harm group.

In September, the trust confirmed it had set up a hotline for GPs with concerns about their patients.

Last year, turnaround director Iain Lynam said in a board meeting that the problem had a “cultural element”. When HSJ asked the trust about this, a spokesman said: “The problems with data management have been allowed to increase and accumulate over a number of years. Rather than working to standard procedures well intentioned staff working at speed developed workarounds and shortcuts. We are now addressing the underlying process weaknesses.”

Non-executive director Sir Norman Williams, former president of the Royal College of Surgeons, asked the board about the “potential liability and what arrangements the trust had in place to manage this”.

The spokesman said: “This is an important issue, and one that will be addressed as part of the review process. However, our immediate priority is ensuring that we quickly identify those patients who may be at risk of harm, eg: through extended waiting times, so we can assess them and, where necessary, expedite their treatment.”

In response to HSJ’s enquiries about the clinical harm process the spokesman said: “Patient safety is our number one priority, which is why we are taking action to address the systemic problems with our data quality. The clinical harm review process involves looking in detail at those patients we judge to be at increased risk of harm as a result of the extensive validation process we are undertaking.”

Two million patient records have been cross-checked by a major London trust following concerns that some patients may have had their care pathways inadvertently terminated.

St George’s University Hospitals Foundation Trust in south west London is currently investigating and assessing whether patients have come to harm as a result of a widespread failure to properly enter patient data on the trust’s electronic medical records system.

Having reviewed the two million records, the trust has identified 129,000 “high risk” patients who are being prioritised for validation.

However the trust has confirmed that it will need to validate more records as the investigation proceeds because it is likely that more ‘high risk’ cases will come to light as the investigation proceeds. The validation process is not expected to be complete until the summer of 2018.

The concern is that two million individual patient records, each of which represent a different part of a patient’s treatment, rather than a real patient, may not have been recorded on the patient administration system (PAS) properly.

This means that whilst a patient may have been operated on, referred for further treatment, then discharged, for example, the pathway may not neccesarrily have been recorded in the electronic patient record.

The trust is confident that the number of patients actually affected is far fewer than two million. However to ensure this is the case, it is checking and validating the electronic patient administration system against other records, whether that means theatre records, other electronic systems or paper records.

Problems arose after a new patient administration system was introduced in 2014 and staff were not given adequate training about how to use it. As a result patient pathways were not properly logged by administrative staff.

The issue was compounded when consultants started recording referrals in a “non-standard” way, entering patient details on a spreadsheet rather than a patient administration form.

“It was a well intentioned workaround [short-cut] with unintended consequences” a spokesman said.

So far there has been no evidence of any patient coming to serious harm as a consequence of the loss of two million records, a spokesman for St George’s said.

But there have been long waiting times: some of the “incomplete patient pathways” date back as far as 2014 when the patient administration system was introduced.

An external company with a team of 40-50 people, has been appointed to help validate and correct patient records.

Patients deemed as “high risk of possible harm” are flagged up and referred to a dedicated in-house team of clinicians for a formal review.

Those patients found to be at high risk of clinical harm are offered expedited treatment.

All high risk patients are expected to have had their records cross-checked by August.

In the meantime the trust is retraining staff, including consultants, about how to input data into the trust’s internal systems.

Resolving the situation is expected to cost St George’s several million pounds.

A spokesman for the trust said: “We have been clear from the outset that our data problems are systemic, and that there will be no quick fix.

“The approximate figure of two million refers to the number of patient records which are incomplete or haven’t been ‘closed’ on our administrative systems. We expect that the majority of these patients will have been seen and treated.

The two million figure refers to the number of patient records held on the trust’s electronic patient administrative system which are incomplete or haven’t been “closed”.

“The elective care (data quality) recovery programme is a key priority for St George’s, and we are determined to ensure that the excellent clinical care we provide is underpinned by sound operational processes.”

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