Missing: the notes of more than a million outpatients

The HSJ analysis of over two million outpatient appointments at 49 hospitals from 2006-08 revealed 54,000 took place without the patient’s full records. If that rate is replicated across the NHS, approximately 1.2 million outpatients in England will be seen without their notes every year.

Patients Association head of special projects Vanessa Bourne said: “It reveals a dreadful cavalier attitude to patients, their safety and their records.”

Despite the risks to patient safety, there is no national standard for the availability of patient records or agreed way to monitor performance. HSJ has been told trusts may downplay the extent of missing records - for example by including scant temporary records or by cancelling appointments when records are not available. This means the real rate of absent records could be even higher.

Most trusts carry out periodic internal audits of the availability of patient notes, although they are not required to do so. Forty-nine trusts responded to HSJ’s request under the Freedom of Information Act for details of their last audit. Outpatient appointments such as radiotherapy and dermatology were audited more often than inpatient or emergency admissions.

Trusts monitored records differently. Those revealing full audit details reported 11 times as many missing records as those that just gave an overall figure (3.3 per cent compared with 0.3 per cent).

City Hospitals Sunderland foundation trust reported the highest rate: 19 per cent of outpatient records unavailable at the start of the clinic. A spokeswoman for the trust said it had given a “true picture”. A new post had been created to address the situation, which was improving, she said.

The last national report into availability of records was published by the Audit Commission in 1999. It said hospitals should aim to have 100 per cent of outpatient notes available and defined those with more than 5 per cent missing as poor. Six of the 49 hospitals had 5 per cent or more missing. On average, 2.6 per cent of outpatient records were missing - down just 0.1 percentage points since 1999.

A Department of Health spokesman said the use of electronic patient records would bring “very real future benefits to patients”.

Where did those records go?

Hospital trusts reporting more than 5 per cent of outpatients’ notes unavailable when needed

Trust, % patient records missing

City Hospitals Sunderland foundation, 19.0

Northern Lincolnshire and Goole Hospitals foundation*, 18.7

Maidstone and Tunbridge Wells, 15.0

Barts and the London, 12.3

Nottingham University Hospitals, 8.0

University Hospital Birmingham foundation, 5.0

Source: FOI releases to HSJ relating to trust internal availability audits 2006-08

*Audit showing misfiled rather than missing records

In figures

HSJ has examined the details of over two million outpatient appointments at 49 hospitals:

• 54,000 patients were seen without their patient records

• 6 out of 49 trusts reported 5 per cent or more outpatient records missing when needed

• 39,323 was the number of incidents reported to National Patient Safety Agency relating to patient documents in 2007

• 1999 was the date of the most recent national report on patient record availability

• 1% is the maximum percentage of records that should be missing, according to Audit Commission. Half of trusts surveyed missed this target

• 1.2 million is the estimated number of outpatients in England seen per year without records

See Neglect of records departments puts patient safety at risk for more.