An audit on problem lists transfers in general practice in Leeds, United Kingdom

Abstract

Background: Problem-oriented medical records are the standard among electronic health records (EHR) but after 50 years of use, problem lists (PL) do not seem to be the solution to clinicians' information needs. Objectives: To perform a quality improvement evaluation of PL content, considering available guidelines on its characteristics (accuracy, clarity, concision, currency) when transferring patients from one primary care organisation in England to another in Leeds. The standard should simply be the need to confirm currency. PL should be ready to be used safely after a brief check-up. Methods: During six months, all patients registering at a primary care setting in Leeds had their PL updated when they were transferred with an existing English electronic medical record. The content of the PL was later analysed by looking for the number of items in both lists (active and inactive), for the presence of duplicates and synonyms, and for items that needed to be added. It is normal practice to review the records at the time of transfer, usually by a nurse or healthcare assistant, but it was done by a general practitioner (GP) aiming to maximise the quality of the final PL. Results: Of the 175 newly registered patients studied, 3077 PL items were collected. Active PL included an average of 5.7 entries per patient, while inactive PL had an average of 11.8 entries. The number of duplicates per patient was about 1.8, while the number of synonyms was around 1.2. Unnecessary items were common. When records were reconciled, there was a 66.7% reduction in active PL entries and an 86.4% reduction in inactive entries. Discussion: Handover of PL among family physicians fails to transfer high-quality data. Different organisations follow distinct patterns in the use of PL. Major changes may be required to improve the flow of accurate, concise and up-to-date information. It could be argued that without further training, the use of clear guidelines or better support from health informatics, the PL will not provide the important summary information that clinicians need, which will affect clinicians' decision-making and to the detriment of patients.