الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
1-Objectives, Material, and Methods The present study was undertaken with the aim of providing a comprehensive assessment of medical record practice in Jordanian hospitals that have been adopting modern medical record system for at least five years prior to commencing the field study in 1990. Three general hospitals were qualified for the study, each of them represents a different health care sector: King Hussein hospital (a 547 - bed Military hospital; Jordan University hospital (a 507 - bed teaching hospital, and Islamic hospital (a 300-bed voluntary hospital). The criteria for the evaluation the different aspects of medical records were prepared after a thorough and systematic review of the relevant literature. The criteria were reviewed by the researcher and scrutinized by the supervisors and necessary changes were introduced to make them explicit, practical and applicable to the study settings. Thus, for each assessed topic criteria checklist was prepared prior to commencing the field study. Data about the structure Qf the medical record department (physical facilities, management, medical record forms, personnel) was obtained from: review of the available written documents as manuals, written policies and procedures, organizational chart, job descriptions, pay roll, samples of . medical record forms, building drawings of the MRD etc...; pre-structured interview with the director of the MRD and appropriate personnel; direct observation by the researcher; and visits to other hospital departments as: OPD, admitting office, personnel department, supply department, etc.. Assessment of the function of filing and record control was done by reviewing the medical records of ten filing shelves randomly selected from the filing area in each hospital. Thus 2938, 1066 and 1234 medical records from Hussein, University and Islamic hospitals respectively were reviewed to determine number of misfiled records, overcrowded shelves, folders with pages projecting out, folders with illegible names or numbers, duplicate records and defects related to the use of the out-card system. Evaluation of the contents of medical records (assembly order, presence of appropriate forms-quantitative review-, completeness of recording and eligibility-qualitative review-and compliance with the general principles of documentation) was based on a random s,ample of 500 records for patients discharged from each hospital during the year 1989. A 1 OD-record subsample was randomly selected from the main sample to evaluate the correctness and completeness of coding and indexing of diseases and operations; compliance with general principles of patient index; and accuracy of discharge analysis. A special questionnaire was developed and distributed to a random sample of 100 physicians and 100 staff nurses at each hospital to assess their attitudes towards the medical record department. II-Results (1) Physical Structure of the MRD: The results of this survey showed that most of the physical conditions of the MRD at the three hospitals were below acceptable standards. The design of the department did not facilitate smooth flow of work; ventilation, air conditioning and heating were below standard; and fire control systems were not appropriate mainly at Hussein and University hospitals. None of the study hospitals was maintaining inactive file area. Hussein and University hospitals had central file area, while at Islamic hospital records of outpatients were physically separated from inpatient records. The conventional open shelf file units were used by University and Islamic ho~pitals, while Hussein hospital was using moveable file units with suspended files. Computer was introduced recently to the MRD at Hussein and Islamic hospitals, while University hospital has not introduced the computer yet. (2) Personnel: Regarding personnel, the majority of the MRD employees at Hussein and Islamic hospitals had never attended a formal training course in medical records (88.2 and 85.7 respectively); while most of the MRD staff at University hospital (87.6 ) attended a special three-month course in medical records. A wide variation was also existing among the study hospitals concerning years of staff experience in medical records.At Hussein hospital, the percentage of staff with experience of four years or more totalled only 29.4 ; while at University and Islamic hospitals the corresponding percentages totalled 71.9 and 85.7 respectively. (3) Management: The MRD at the three hospitals had organizational chart, written policies, personnel budget and performance appraisal system. On the other hand, none of the study hospitals had written objectives, written plans, written procedures or separate financial budget. Job descriptions were found at Hussein and Islamic hospitals only. The percentage of completeness of the available written policies was below 40 for the three hospitals. The directors of the MRD stated that they were given enough authority regarding work assignments, leaves of the MRD staff and performance appraisal. However, they admitted that they were not performing systematic planning or evaluation of the medical record services. (4) Forms Design: The results showed significant variation among the study hospitals regarding the overall compliance with forms design criteria. Islamic hospital had the highest rate (87.6 ) followed by University hospital (75.1 ) then Hussein hospital (70.6 ). (5) Filing and Record Control: The results showed significant difference between the study hospitals with respect to most of the filing defects recognized by the study.