Reader Question: Think how records might be used before discarding
Accreditation, legal concerns factor into decision
Question: How long do we need to keep quality improvement (QI) and peer review documents before tossing them out? I’m thinking of department or team QI reports, minutes from QI meetings, peer review worksheets with no adverse findings, and similar documents. We’re trying to implement a policy of discarding these materials after two years to free up storage space.
Answer: As with most questions about document retention, there is no easy, absolute answer to when you can discard those materials. Many experts advise holding on to the records as long as you can, just to be safe, but the best advice is to consider carefully how each of the documents might be used in the future and let that guide your retention policies, says Matthew Rosenblum, chief operations officer for privacy, quality management, and regulatory affairs at CPI Directions, health care consultants in New York City.
He suggests you consider three areas in which you might possibly need those documents in the future: clinical, legal, and accreditation.
From a clinical standpoint, peer review requires providing the reviewer with enough longitudinal information to track a physician’s performance over time. "So you really don’t want to be throwing this information out every two years," he says. "If that information is going to be valuable to the peer review process, you have to keep it for some length of time, certainly longer than two years."
For legal concerns, Rosenblum says you must consider how long the records could be useful in a malpractice case. "If an infant is discharged tomorrow, that infant has 21 years to come back to the hospital with a lawsuit," Rosenblum says. "So the hospital must keep some records that long, but I’m not suggesting you keep all your peer review records that long. Some will be helpful, however, in the context of substantiating why treatment occurred as it did. If the prosecuting attorney wants to know how the hospital determined that the doctor was providing good care, you might want to show the peer review records."
How much of that information you keep around "just in case" depends a lot on the type of care you provide. Long-term care facilities or others considered at low risk for lawsuits can be more liberal in what they discard, he says. An acute-care provider should be more cautious.
Accreditation concerns also will guide how long you keep some peer review and QI documents. The Joint Commission on Accreditation of Healthcare Organizations and other accreditors will expect to see a longitudinal analysis of physician practices, so documents must be kept for some time. Rosenblum notes, however, that you don’t necessarily have to keep all the original documents or entire documents. In many cases, the records or the pertinent information from individual records can be recorded in computer files or otherwise summarized. Information can be integrated into an intermediate trend analysis that will preserve the data for long-term study.
He makes these other recommendations:
- Consider the experience level of your physicians. A teaching facility or a provider with generally less experienced physicians may need to keep peer review documents longer than other providers. The chance of a future lawsuit is increased, and you need the trend data to measure quality.
- High-risk or unusual medical procedures could require longer retention. Questions are more likely to arise about high-risk or unusual procedures. Even routine but potentially risky activities, like medication administration, should be considered for longer record retention.
- Avoid inflexible rules about when to discard records. Life would be easier in some ways if you could just say "keep everything for five years and then throw it out." But simple is rarely the best way to go. Some records must be kept longer than others.
- Look for duplication of records. Even for important information that must be retained, you don’t need multiple copies. For instance, you might have QI reports or trend information attached to monthly meeting minutes, but the same reports are in an individual’s file. "In that case you could throw out the meeting minutes three or four years down the road, but maybe not the original report if it has to do with a physician’s performance."
- [For more information, contact:
• Matthew Rosenblum, Chief Operations Officer for Privacy, Quality Management, and Regulatory Affairs, CPI Directions, New York City. Telephone: (212) 675-6367. E-mail: CPIdirections@att.net.]