Clear out the shelves and still protect your future

File retention policy works well at SC hospital

File retention is a constant problem for many health care facilities, with decades-old records often piled in valuable office space or stored off-site at a high price. Staffers turn to the risk management department for advice on what to throw out, but often there is no clear answer.

That was the situation at Columbia Colleton Medical Center in Walterboro, SC, until December 1996, when the hospital implemented a specific policy on file retention. The new policy was prompted by the number of files piling up at the hospital, says Patricia Keenan, RN, MSN, director of quality and resource management.

"Papers were stacking up all over the place," she says. "In a lot of cases, we were keeping them for 20 years, and there was no explanation for why. No one knew what to do with them."

Guesswork is not the best policy

Part of the problem, Keenan determined, was that the facility had no policy on file retention for the staff to consult. As a result, staffers often decided to err on the side of caution by keeping everything. Even if staff consulted Keenan’s department or other managers for advice, the answers were sometimes contradictory or a confusing recitation of laws and regulations. That also caused staff to fear taking responsibility for throwing out needed documents.

Keenan decided to solve the problem, or at least part of it, by writing a policy on file retention. That meant doing research on all the state laws that dictated which files could be discarded, plus gathering advice from legal counsel and others about the general need to retain documents.

Most of the documents in question concerned the medical staff. The resulting policy is specific to South Carolina requirements, but Keenan suggests that most of it could apply anywhere in the country. Columbia Collet’s policy could be used as a base and modified to accommodate local requirements. (See policy, inserted in this issue.)

The main reason to keep medical records is that you never know when a case will result in a malpractice claim, says Sam Bishop, ARM, director of risk management for Promina Northwest Health System, the Atlanta company that includes Kennestone Hospital. He suggests finding out how long the statute of limitations for malpractice claims is in your area to determine how long you should keep records. That is especially true of patient records, although there may be other rules that apply to other types.

Some risks outlast statute

He points out, however, that the statute of limitations period should be considered the minimum time you need to keep patient records. Some circumstances, such as exposure to hazardous materials, can extend the statute of limitations beyond the normal period.

"I recommend keeping the records longer than the statute of limitations if you can," Bishop says. "The longer the original records are kept, the better off you are. At some point, you may have to make a decision that it is just impractical to keep them all, but try for as long as possible."

It is acceptable to put the records on microfilm or microfiche to make them easier and less costly to store, but Bishop recommends putting that off until after the statute of limitations runs out.

Surprises about what was expendable

When all the research was done at Columbia Colleton, there were some surprises about what could be discarded. Some of the records in storage were from physicians who had not been on staff for 20 years. The new policy calls for records to be trashed after 10 years.

"We were hoping we could do something with the medical staff bylaws and minutes because they were getting so voluminous, but we found we have to keep those permanently," Keenan says. "With deceased physicians, we can shred their files immediately. You can’t sue someone who’s dead."

The hospital’s chief executive officer and chief of staff approved the policy before it was implemented. There was no disagreement from any hospital staff, Keenan says. In fact, they were glad to have a policy in place.

"All you have to do is say what your policy is and follow it," she says. "Your whole facility is going to be taken up with boxes of paper if you don’t do something."