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Journal of the Academy of Hospital Administration

A study to Ascertain the Misuse/Wastage of Medical Record Forms at a Tertiary Super-Speciality Hospital

Author(s): Anupam Chattoraj*, S Satpathy**, R K Sarma***

Vol. 16, No. 2 (2004-07 - 2004-12)

Key Words:

Medical record forms, consumption, wastage, misuse

Key Messages:

A sizeable number of printed forms are misused or wasted in hospitals. It is possible to calculate wastage/misuse by scientific methods.

Measures should be taken to reduce wastage of forms by increasing awareness of staff, printing the cost of form in one corner and providing plain paper for rough work.


The tertiary level super speciality hospital earmarks approximately 0.7 to 0.8% of the budget for consumables (Non Plan) for printing of forms. In real terms the expenditure on procurement and printing of stationery has been registering a sharp rise, from Rs 17.22 Lakhs in 2002-03 to Rs 30 lakhs in 2003-04. A prospective study was carried out in the months of March, April and May 2004 over a period of three months with the aim of making an attempt to find out the possible wastage of medical record forms in various areas of the hospital. The stock of selected medical record forms in the study areas were ascertained before the beginning of the study. The number of forms issued during the study period to the study areas was accounted for. Balance stock of the forms was counted at the end of the study. The difference between the sum of the opening stock and issue quantity and balance stock gave the apparent consumption of the forms. At the same time a study of sample case sheets in the study areas as well as in the Medical Records Section was undertaken to find out the approximate number of each of these forms used per in patient document. These figures, compounded by the total number of admissions/ OPD attendance in the study areas, helped us to arrive close to the actual consumption figures of these forms. The difference between the apparent consumption and actual consumption would be the wastage/ misuse of the forms. The results showed that a sizeable number of forms are misused or wasted. This was confirmed through observation during the survey also. Measures should be taken to reduce wastage. Awareness of the cost of the printed forms need to be spread amongst users. One way of doing this is to print the price of each form at bottom left hand corner. Efforts have to be made by the ward in charge sisters to keep the forms systematically in the racks meant for them so as to facilitate easy retrieval of the right form at the right time. Some general stationery in the form of plain paper may be supplied to the user areas to avoid misuse of the more expensive printed forms for rough work.


Records are necessary for the practice of medicine, as are medications for effective treatment.1 Historically, medical records have been a chronological assembly of facts, in the form of notes, forms, reports and summaries. People read from forms, write on forms, spend billions of hours handling forms and filling forms.2 The printed form is a tool with a message or job to do. It is the physical carrier of data-of information. It provides information for the attainment of objectives, facilitates decision-making, and improves operations. They are the vehicles for most communications and the blueprint, for, eventually, every activity.3 Purpose of medical record forms is to provide for easy and quick recording of relevant information for orderly, compact information storage and for easy and speedy retrieval. The number and types of forms in use in a hospital depends upon the nature of the hospital. The adoption of forms to fit its needs is the hospital's own responsibility.4 The basic set of forms in the hospital include the Front/Face Sheet, consent for treatment, correspondence and legal documents received about the patient, discharge summary, admission and progress notes, nursing notes, operation notes, consultations, pathology and other reports and medication charts.5 Medical Records Department (MRD) has become an essential department of every hospital. This is based on the principle that "people forget, but records remember". The hospital earmarks approximately 0.7 to 0.8% of the budget for consumables for printing of forms. In real terms the expenditure on stationery has been registering a sharp rise, the sharpest being in the last year (approximately Rs 12 lakhs). However, the rate at which new forms are being designed and introduced through the hospital stores by the departments may well lead to insufficiency of funds in the future for printing all the forms needed for patient care.


Around 180 types of printed forms are used for various patient care activities at AIIMS Hospital. These forms can be classified under the following broad categories:

  • Forms used for patient care
  • Core forms (basic medical record forms)
  • Diagnostic forms
  • Department (discipline) specific forms
  • Forms for Administrative purposes

The study sample comprised of all the core forms (numbered forms MR 2- MR 10) of the medical records department, and 10% of the other categories of forms, selected by stratified random sampling. Thus, a representative sample of Diagnostic, Department Specific and Administrative forms selected by random number technique were included in the study. In addition, the OPD card was also selected, as it is one of the most commonly used forms with a large amount of resource spent on it by the stationery stores. During the prospective study, effort was made to correlate the consumption of commonly used forms with the OPD attendance and in patient admissions in the representative areas. One Medical Ward (C-2), one Surgical Ward (C-7), one super specialty (Urology) ward (C-4) and one Emergency ward (C-6) were selected as the "case mix" of patients in these four wards were considered to be 'representative' of the hospital in patients. These wards were chosen as they represented a complete spectrum in the form of an acute medical and an acute surgical ward, a highly specialised ward and an emergency ward where patients are admitted under all specialities.

The following methodology was adopted for the study:

  1. The stock of selected medical record forms in the study areas were counted at the beginning of the study. This was the opening stock.
  2. The quantity of same forms issued during the study period was ascertained from the hospital stationery stores records.
  3. Balance stock of the forms was counted at the end of the study in these areas.
  4. The difference between the sum of the opening stock and issue quantity and the balance stock at the end of the study period gave the apparent consumption of the forms.
  5. At the same time, a study of sample case sheets of indoor patients in the study areas as well as in the Medical Records Section was undertaken to find out the approximate average number of each of these forms used per indoor patient document.
  6. Outpatient attendance and the number of inpatient admissions during the months of March 2004 – May 2004 were ascertained from the medical records department.
  7. The average number of each of these forms per inpatient and outpatient record were multiplied with the total number of admissions and outpatient attendance respectively during the study period. The figures arrived at was assumed to be the actual consumption of each of these forms.
  8. The difference between the actual consumption and the apparent consumption was assumed to be the wastage/ misuse for each form.
  9. This wastage was expressed as a percentage for comparison purposes.


Forms are being frequently used for purposes other than for keeping medical records. As revealed during informal discussions with residents, a lack of awareness among the physicians as to the purpose of the various forms was also found contributory to the misuse of forms. The Consultation Record forms, meant for use by physicians of one discipline seeking consultation from the physicians of another discipline, is used for a variety of purposes like writing complaints, sending requisitions to stores etc. In some wards, forms were not kept in the racks meant for them. Considerable time and effort had to be spent to locate a particular form at times during the survey. Clinicians, being pressed for time, used to pick up any type of form readily available for recording information about the patient, even though the particular form was not meant for that particular purpose. Because the individual forms are kept together in the pad with an adhesive, often more than one form are detached when the doctor tries to remove one. These are then tagged to the case sheet irrespective of their utilization subsequently. No effort is made by the sister to remove the unused forms at the time of dispatching the case sheet to Medical Records Department.In the absence of supply of Plain Paper for miscellaneous and rough work through the Stationery Stores, all categories of health workers tend to make use of forms for a myriad of activities like writing prescriptions, issuing loan chits, making calculations for dosages of drugs, explaining treatment to a colleague etc. Even the expensive OPD cards are routinely used by registration staff for noting down the list of doctors available in the OPD that day and for recording the number of patients allotted to individual doctors.


To keep pace with the development in medical science, a large number of sophisticated investigations have been instituted and erstwhile forms cannot meet the requirements of all such investigations. Hence the cost of printing forms is spiraling to keep pace with the introduction of new forms. A sizeable number of hospital forms are misused or wasted because of various reasons ranging from lack of awareness among users as to their purpose and cost, lack of supervision in wards, to non availability of plain paper for rough work. Computerised patient records management in an overall integrated hospital management problems can solve many of the logistical problems associated with paper based medical records.7 Till that happens, in the wake of the resource crunch that Public Sector healthcare institutions are wont to face, to ensure effective and efficient utilization of medical record - forms, it is imperative that all efforts are made to reduce misuse / wastage of printed stationery.

Table 1: Apparent consumption, actual consumption, wastage/ misuse of different forms

Form Title Stock before Study Issue during 3 months Balance Stock at end of Study Apparent Consumption Actual Consumption Wastage/ Misuse % Wastage
Diet Slip 2600 200 2150 650 360 290 44.6%
General History & Physical Exam 1500 8200 400 9300 8000 1300 16.25%
Blood requisition slip 2250 3700 3800 2150 1800 350 16%
Consultation Record 1950 Nil 700 1250 1110 140 11.2%
Fitness Certificate 950 300 1000 250 225 25 10%
Discharge Summary 4250 500 2600 2150 1950 200 9.30%
Admission slip 900 2300 1400 1800 1700 100 5.55%
OPD card 9295 1,52,050 4115 1,57,230 1,50,000 7030 4.47%
Progress Report 1300 7300 1300 7300 7000 300 4.11%
Nurses Notes 2200 8100 1500 8800 8500 300 3.40%
Bacteriology form 3100 5000 2650 5450 5350 100 1.83%
Consent Form 2130 200 1450 880 875 5 0.5%
Doctors Orders 1100 900 500 1500 1500 nil 0%
Intake Output Chart 2900 1600 2700 1800 1800 nil 0%
Operation Record 3000 nil 2700 300 300 nil 0%
X-ray Form (Yellow) 2200 2400 2900 1700 1700 nil 0%
ECG request 2400 2200 2600 2000 2000 nil 0%
Haematology 1850 2200 700 3350 3350 Nil 0%
Clinical Pathology 3100 700 2600 1200 1200 Nil 0%
MRI request 1500 Nil 1500 Nil 5    



  1. Huffman EK, Manual For Medical Record Librarians, Physician's Record Company, USA, 1960, 1.
  2. US News and World report, June 20, 1977, 48.
  3. Elias M Awad, Richard D Irwin, 'Systems Analysis and Design', Homewood, Illinois, 1979, 209.
  4. American Hospital Association, Medical Records Forms For Hospitals, Guide To Preparation,1972, 32.
  5. WHO Medical Records Manual - A Guide For Developing Countries, AITBS Publishers, 2004'.9
  6. Medical Records Keeping, Do's and donts'- Express Healthcare Management.31st March 2002.
  7. Centre for Developing of Advanced Computing (CDAC) Hospital Information System http// html/hisrecords.asp.2003.

* Resident Administrator, Deptt. of Hospital Administration, AIIMS, New Delhi
** Associate Professor, Deptt. of Hospital Administration, AIIMS, New Delhi
*** Medical Superintendent and Professor and HOD, Deptt. of Hospital Administration, AIIMS, New Delhi

Journal of the Academy of Hospital Administration, Volume 16 No. 2 July-December 2004

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