Last updated at 15:03, Sunday, 19 August 2012

IF you’re considering taking on Sara Gabriel’s job, there are three things you should bear in mind; organisational skills are non-negotiable, you better have the patience of a saint and claustrophobia is not an option.

I have been with Furness General Hospital’s medical records manager for all of 10 minutes before (and this is no reflection on her conversation or company) I have a thumping headache. And as she shows me around the libraries where she works, Sara can’t help but laugh at the look on my face.

“There’s more than a quarter of a million sets of patient notes on site at Furness General Hospital,” she tells me, as I stare around at a filing system which makes perfect sense to her but simply astounds me.

Sara and I are stood in one of the hospital’s three libraries, surrounded by thick walls of notes reaching from floor to ceiling, a small gap allowing for the width of one person within each shelf.

The medical records team is responsible for supplying FGH’s doctors and nurses with the individual patient records stored here, whenever and wherever they are needed.

Every patient treated at FGH has a special prefix number which stays with them for life and dictates where in the hospital they are filed.

And each time they attend hospital, their paperwork multiplies.

Sara explains: “You can’t envisage how poorly someone’s going to be, how many times they’re going to come back, and notes grow and grow and grow.

“The average set of notes is two inches thick, but you have some patients who need full boxes to themselves.

“We’ve got a cupboard of what we call ‘fat notes’ – records which won’t fit into the normal shelves.”

The libraries here are so full that 20,000 sets of notes are being moved to a specially-built centre at the Royal Lancaster Infirmary, ready to be sent to and from FGH whenever needed.

Sara’s staff are also given set areas of the hospital’s library they are responsible for “culling” – going through each file and working out what can be disposed of.

In the hospital’s archives, deceased patients’ notes have to be kept for nine years, or longer if they were a psychiatry or a maternity case.

In a bid to address the problem with finding room for their records – one faced by hospitals all over the country – the University Hospitals of Morecambe Bay NHS Foundation Trust, which runs FGH, plans to have all of its patients’ notes scanned into a computer system.

They hope their records will be completely electronic within two years.

But for now, there is a lot of paperwork to be handled and it’s up to Sara’s team to make sure it’s done properly.

Her 23 staff are responsible for “pulling” 14,000 sets of patient notes every month.

This can be for a patient who has just been admitted to a ward or one who has come in for a scheduled operation.

Each team member is also responsible for certain sets of clinics every week, taking lists of outpatients, finding their notes, making sure nothing is missing, then filing them in the order the doctors will need them.

And every employee has their own prefix numbers – patient records they are responsible for filing back into the libraries once the doctors and nurses have finished with them.

But their main skill is in the “pulling”.

“It’s not as easy as just going to one rack and seeing them there,” Sara tells me, “it’s often wide open where those notes could be and it’s your job to find them.

“On average, of a clinic of 20 people, there’s usually eight or nine sets of notes ‘missing’.

“Well, we class it as missing because they’re not in the library at that time. They’re not gone, we just need to work harder to get to where they are. It’s very, very rare that we can’t find them. But that’s where I come in. I have my own clinic lists just like the others, but I’m also responsible for tracking down anything my girls can’t find.”

There are some breadcrumb style clues left for Sara and her team to follow when such a search begins.

Whenever records are taken from library, a tracer card will be put in place to show where they have gone.

Using this, and the other electronic systems and schedules at their disposal, the team member responsible will laboriously work out where in the hospital the records were last seen.

This could be on a ward – in the case of a patient who has been admitted before they could come in for their clinic.

It could be in another area of the hospital – because a patient’s notes are still waiting to be brought back from a previous clinic.

Sometimes, it could be a UHMBT patient has previously been seen at one of the trust’s other sites – at which point Sara’s staff will hit the phones to call on their colleagues in Kendal, Lancaster, Ulverston or Morecambe.

“A lot of people think you’re just sat behind a desk,” Sara says, “but it’s physical, hard work.

“You’re all over the place – in the wards, in the libraries, sometimes you’re just running around chasing your tail.”

In cases where sheer perseverance doesn’t pay off, Sara’s sizeable team comes into its own.

“If it’s a really urgent case, everybody just drops everything”, she tells me.

“They’re a fantastic team – they do absolutely everything to help you look.”

And, Sara tells me, the reason they work so hard is inspired by the same motivation as every other member of hospital staff – the patients.

Sara says: “We have to be really on the ball because, at the end of the day, if a patient’s notes aren’t there, then that patient is at risk and that’s just not acceptable.

“It’s the challenge for me – knowing that it’s down to you to make sure that every doctor and their patients have those medical records waiting for them.

“You have to think, ‘that could be my mum sat there, or my dad’ – you’ve got to think about the real life people behind these notes.”

First published at 16:19, Friday, 17 August 2012
Published by http://www.nwemail.co.uk