Mersey Care CMHT Project Charter

Report to the Meeting of the Trust Board

Date of Meeting:Enclosure:

• A live library only holding case notes which have been used for the last 4 years (since 2010)
• Relocation of the deceased case notes into an offsite storage facility for deep storage managed by Iron Mountain, the sole and direct award supplier for off-site Records Management services to the Government and Crown Commercial Service.
• Relocation of the inactive case notes 5-8 years into an offsite storage facility for deep storage

Business Case

Centralisation of Medical Records

Detailed guidance on how to complete this Business Case template is available on the Trust’s Intranet site at: nww.staffweb.cumbria.nhs.uk

Document Control

Contact

1. EXECUTIVE SUMMARY

An initial business case (March 2013) had been made and accepted by Executive Management Team (EMT) for centralising two existing Medical Records libraries i.e. the libraries at the Cumberland Infirmary (CIC) and West Cumberland Hospital (WCH) into one unit.

This was revisited in January 2014 and EMT requested that more options be investigated and costed further. It was noted that running a 24/7 service would not be feasible until a later date (which was not prescribed), and increasing staff costs was not supported at that time due to financial pressures.

This revised case aims to improve quality standards around medical notesby providing a first classmedical records library for the records currently being held in the libraries at CIC and WCH in a unit close to the Cumberland Infirmary. This will be achieved by ensuring there is sufficient staff at WCH and CIC to manage the throughput together with a suitable centralised facility. A facility at Carlisle would be the preferred choice as the CIC site is now predominantly the ‘hot’ site for trauma, high risk surgery and emergency patients whereas the WCH site is predominantly an elective site.

This would be achieved by approving Option 5 described below and agreeing to the increase in staffing numbers:

A live library only holding case notes which have been used for the last 4 years (since 2010)

Relocation of the deceased case notes into an offsite storage facility for deep storage managed by Iron Mountain, the sole and direct award supplier for off-site Records Management services to the Government and Crown Commercial Service.

Relocation of the inactive case notes 5-8 years into an offsite storage facility for deep storage

Option 5 will be implemented in two phases which would allow the existing libraries breathing space until the new site for a centralised library could be formalised and any refurbishment work undertaken.

Relocation of the deceased case notes and the inactive case notes has already commenced following approval from the Executive Management Team to undertake Option 5.

A facility (Unit G2) has been located on the Kingmoor Park Industrial estate which would be suitable.

A medical records area has been identified in the new build at WCH to receive and retrieve medical case notes for the patients attending Outpatient clinics and admissions to the WCH site. It is envisaged that the preparation of medical case notes for admissions to the WCH and the Outpatient Clinics held at WCH and in the surrounding community would be undertaken at WCH.

Once phase 2 of the WCH new build is completed, the current medical records storage facility at WCH will be demolished.

1. BACKGROUND

The aim of this proposal is to improve quality standards around medical notes, namely improve tracking, delivery, retrieval and contents. Mortality Review, Keogh team and Chief Inspectors of Hospitals highlighted serious shortcomings with the standard of medical records.

There hasalso been no provision made for a Medical Records library in the WCH new build. The new area on level 4 (old pathology lab) requires to be vacated by June 2015; this area will be demolished to allow the new hospital build to progress. Current floor area, over 5 separate areas is approx. 773m2. However the overall area is too small and inadequate to hold cases notes for 8 years.

The premises revenue costs for the current medical records facility at WCH have been estimated at c£33k (based on ERIC data), the saving of which will have been offset against the costs of the new hospital in the WCH redevelopment business case. If the new hospital build had included provision for medical records then the additional capital cost would have been an estimated £600k.

CIC Medical Records facility at Port Road (810 sq metres) is beyond full capacity and therefore has no spare capacity to cater for any workload increase. The Trust also leases an off-site storage site on Canal Store for the deceased records (400m2). Recent Fire Officer and Health and Safety Officer inspections have raised significant concerns mainly due to overcrowding at both WCH and CIC Port Road.

Lease on Port Road expires in May 2015.Under the terms of the leaseto make Port Road, marketable as a storage unit, the Trust would have to demolish the mezzanine floor, remove the offices, toilets, air conditioning units, windows etc. Trust would also have to make good all the external fittings that they have failed to maintain. It has been estimated that this could cost over £126k. To allow this to happen would mean realistically vacating Port Road before Dec 2014.

The future plan for all medical record departments could be electronic storage of medical records but this will not be available for at least 5 years and probably longer i.e. 10 years. It will require significant capital expenditure >£3m.

Minimum space requirements

Facilities

Current

Required

The Health Records libraries at CIC and WCH are not fit for purpose and present major Health and Safety and Fire Risks to both staff and the patient’s case notes ultimately affecting the service to the patient.

At the WCH site additional space has been identified on Level 4and converted to create an additional library to be used until the centralisation of the libraries. This will allow the 3,500 medical case notes which were on the floor to be filed on appropriate racks. It should be noted that this new area has to be vacated by July2015 to allow the Phase 2 work of the new build to proceed. The rest of the medical records storage facility will be demolished once the Phase 2 of the WCH new build is complete in 2017.

At the CIC site the case notes which cannot be filed into the current library, due to lack of space, are currently filed into numbered boxes.

The current staffing levels are also inadequate to meet the workload demands. The current service has failed to attract permanent staffing and the employment of bank and agency staff has not provided the reliability or commitment required for providing a first class service.

Libraries

The table below shows the number of medical case notes currently held in the two libraries:

Live Library

The libraries on the WCH and CIC sites hold medical case notes which have been used for the last 8 years. Any patient case note which have not been used for the last 8 years are destroyed or archived following the Health Records Creation, Retention and Destruction Procedure.

Currently the sites are culling the following case notes:

CIC-August (88%), September (66%) as of 3/10/2014

WCH -No culling had taken place since December 2013 due to

staffing issues, however this has now commenced

Deceased library

At the CIC site the Trust leases an off-site storage site on Canal Court for the deceased records (400m2). Deceased medical case notes on both sites are managed following the Health Records Creation, Retention and Destruction Procedure.

Currently the sites are culling the following ‘deceased’ case notes:

CIC-October 2006

WCH-October 2006

Workload

The table below outlines the .number of medical case notes the Medical Records department processed in 2013/14:

*It should be noted that these figures include multiple email requests for a set(s) of case notes due to the first request not been actioned immediately. These figures have been adjusted when calculating the amount of time/staff to manage these requests.

As part of the medical records staff consultation the workload figures for medical records were reviewed for the previous 12 months i.e. 1 October 2013 to 30September 2014.

This does show that there has been an increase in the workload of medical records by 100,000.

Scanning

The medical records department at the CIC site do have the facilities to scan. Scanning was first introduced tothe Trust in 1999 to reduce storage, create space and develop an Electronic Patient Record (EPR). By 2001 all deceased notes at that time had been scanned and live notes were starting to be scanned. In 2007 a new improved scanning system was introduced (WINDIP). In the past however as staff left they were not replaced. Currently we do not actively scan to create capacity.

The average time taken to prepare and scan a set of case notes including previous volumes is 2 hours. If the department were to scan the 2010 inactive case notes in 2015 and move forward each year whilst culling earlier years in line with the Retention Schedule we would need on average to scan 12,168 case notes each year. The table below shows the additional resource required to undertake this option:

Scanning can support the management of medical case notes but as noted above it is resource intensive and a time consuming option.

CODING

As you are aware patient’s episodes of care are coded to ensure the Trust receives the correct tariff. The coders use the discharge letter and the medical case notes to collect the tariff, however only 85% of case notes are available when the coding is undertaken. To enable the Trust to maximise coding if the medical records business case was approved it would enable 95% of medical case notes to be available when the coders are coding the patient’s episode of care. This improvement equates to £227K of additional income for the Trust.

CANCELLATION OF THEATRES

The table below shows the number of patients whose procedures were cancelled due to the lack of medical case notes.

The 27 patients cancelled equates to £108K of lost income.

CASE FOR CHANGE

Given the challenges outlined, this paper sets out the changes required to address the current inadequacies in the medical records service. Improvement to the medical records storage and to improve the quality standards around medical notes; namely improve tracking, delivery, retrieval will be achieved by:

Leasing a facility for the storage of all current volumes currently in the libraries at CIC and WCH which have been active in the last 4 years.

Relocation of deceased medical case notes from the libraries in WCH, CIC and Canal Court at Carlisle to an offsite storage facility for deep storage managed by Iron Mountain, the sole and direct award supplier for off-site Records Management services to the Government and Crown Commercial Service.

Relocation of inactive case notes (5-8 years) from the libraries in WCH and CIC to an offsite storage facility for deep storage managed by Iron Mountain.

Establishing a fully resourced and structured staff base at CIC and WCH ensuring 24/7 access to patients medical case notes.

Improving transportation links between the hospital sites.

Funding and establishing a permanent Data Quality team, based at the Cumberland Infirmary, to ensure the CQC audits are ongoing and culling merging and the actioning of deceased notifications are kept up to date. This will ensure the library is kept to its minimum size at all times.

It is envisaged that the preparation of medical case notes for admissions to the WCH and the Outpatient Clinics held at WCH and in the surrounding community would be undertaken at WCH.

Staffing Requirements

As part of this case the existing establishments and job roles within medical records must be addressed. It is essential that permanent staff are appointed to provide a robust structure to enable the workload to be serviced efficiently and effectively.

The current Medical Records budgeted establishment is shown in the table below:

To ensure safety of service significant amount of overtime/bank and agency work is currently being undertaken. This causes a cost pressure to existing budgets.

Following consultation with the medical records staff the following establishment is required:

The proposed structure can be seen in Appendix 1.

This will ensure the medical records department can deliver a 24/7 service and have sufficient supervisory cover to manage the staff.

At the Carlisle site there will be 5 teams of 3 medical records clerks who will participate in the shift rota in the centralised library which will ensure delivery 24/7. Each team will be led by a Band 3, Supervisor. It has been agreed to adopt the current shift pattern that is currently worked within the Estates department at the West Cumberland hospital. This is a tried and tested shift pattern which works on a 5 week rota system. The shift pattern comprises of first, back and nights. This rota also incorporates a proportion of annual leave to ensure cover. (See Appendix 2).

At the West Cumberland Hospital there will be cover between 6.00 a.m.-10.00 p.m. There will be a Band 3 Supervisor between 8.00 a.m. – 6.00 p.m. Out of hours the medical records clerks’ point of contact and supervision will be the Porters Team Leader.

The staffing resources required to provide an effective and efficient service for the patients and to meet CQC standards based on the actual workload for 2013/14 is outlined below:

The figures in the table above have been calculated using the modelused by the Medical Records unit in Northumbria Heathcare NHS Foundation Trust. It is noted that in the period 01/10/2013 – 30/09/2014 there was an increase in 100,000 case note movements. However, to calculate the staffing required the 2013/14 figures were used as it was felt the increase in the updated figures were due to the 18 week RTT recovery plan and as it is also recognised that the medical records unit ambition is to drive out a 10% efficiency with the centralisation and implementation of Option 5.