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Lean Events Archive

Medical Records: Flow of Notes

On this page:


  • To understand the current issues surrounding the flow of notes for outpatient, elective and non-elective admissions.
  • To produce a future state map that addresses the issues of notes not going to coding within 48hrs post discharge.

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Lean Event Focus and Participants

A lean event mapping the current state process, identifying waste in the process and designing the future state process was held on the 11th July. 

The Group map out the current workflow using post-its

Key stakeholders that attended the event include:

  • Hawkins Mark
  • Bendell Dominique
  • Stevenson James
  • Fiona Bird           
  • Flower Jessica
  • Peregrine Ben
  • Cox Heidi
  • Oliver Michael
  • Maidment Julie
  • Cropp Jennifer
  • Dando Jenny
  • Barnes Patricia
  • Harding Michelle
  • Breeze Cathy Webb
  • Marden Bernie
  • Burt Suzanne
  • Jeffrey Shirley
  • Winsley Alan
  • Coles Alison
  • Ellis Wendy
  • Wiseman Jill
  • O’Callaghan Shelly
  • Lewis Lisa (Facilitator)

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Lean Event Discussions

Current State Mapping

The group split into three and mapped the current state flow of notes process for Outpatients, Non Elective and Elective. 

As you can see the processes look quite complicated, especially for elective admissions.  The group then did some analysis looking at the waste in the process, number of steps, bottlenecks etc. 

This exercise got the groups thinking about value and what adds value to the patient in this whole process.


Dr Bernie Marden (Consultant Paediatrician and Neonatologist) said:

"Everyone feels instinctively that some processes around the clinical record are more complicated then they need to be. It was really interesting to see the complete journey in relation to a clinical episode and gain perspectives from all staff involved both clinical and clerical. I am confident we can use this new understanding to make significant improvements"

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What Does Good Looks Like?

In the afternoon the group focused on describing ‘what good looks like’ which aims to address the issues raised in the morning by coming up with the solutions.  Below are some of their drawings with the main points being;

What a good Elective process could look like

Key points the Elective Group raised were:

  • EPR (Electronic Patient Record) is the Future
  • Same day appointments for patients to reduce the amount of note moves and improve pt experience
  • Orange stickers to be put on notes by ward clerks
  • Holding bay in medical records for pre assessment appts
  • Tracking accountability/training
  • More ward clerks to cover weekends and out of hours

What a good Non Elective process could look like

Key points the Non Elective group raised were:

  • Temporary notes to be correctly created
  • Patient to not leave the ward without main or purple folder
  • Same day pick up for collection of case notes
  • Automatic discharge summary to GPs
  • Access control to scan to be sorted

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Action Plans

The action plans below detail the tasks that now need to be completed for the process to be re-designed.   

Flow of Notes - Action Plan

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