Save reimbursement costs for lost patient property

Is your ED too often paying out hundreds or thousands of dollars for lost patient property? That was the case at Harborview Medical Center in Seattle, where 300 incidents occurred in a single year.

"Two or three of those incidents were reimbursable ones where we had no documentation of what happened to the article, even though staff remembered seeing it, or pre-hospital agencies documented that they delivered it," says Darlene Matsuoka, RN, BSN, CEN, CCRN, the ED’s clinical nurse educator.

In a single year, patients were reimbursed for a $3,000 ring, $1,000 dentures, $1,500-$2,000 hearing aids, necklaces, coats, and prosthetic devices, she reports. "We even reimbursed for a lost plane ticket."

To fix this costly problem, a new system was developed for patient property. A multidisciplinary committee with nurses from the ED and other units was formed to create a system that made staff accountable for the property they dealt with, but also put the onus on the patient to keep track of his/her own property. "They wanted to decrease property loss and make the system efficient enough that anyone could track down property items," says Matsuoka.

The group came up with a radical solution: to put valuables and property in sealed bags, but without inventory of the items. "It is similar to using a safe-deposit box in a bank," she says. Sealed bags are provided, with the ED responsible for whatever is placed in them, but the patient is responsible for whatever is kept out of them. "In other words, a patient could have $2 or $2,000. The money would be put in a valuables envelope, sealed, and not be counted," says Matsuoka.

Patients witness the items being placed in the bag and are asked, "Is this everything you want in this bag?" If the patient is unresponsive, it becomes the responsibility of two staff members to search the clothing for valuables to lock up. Large bags are used for clothing, and small bags are used for money and jewelry. The bags are bright orange so that they are very visible, and they are opaque to hide the contents and discourage theft.

For patients who go to floors with room lockers, the clothing bags travel with them underneath the stretcher, and if the unit has no room lockers, the bags go to a room managed by the transportation department. The smaller bags containing valuables get locked in the ED safe.

Staff document the bags of valuables and clothing on the "property tracking form" with a checklist for contacts, glasses, dentures, hearing aids, canes, walkers, and wheelchairs. "There are columns on the form that allow patients and staff to add or remove bags from the tracking system," says Matsuoka. "There are places for staff signatures, so we can track who dealt with the items." If patients refuse the securing of property, this also is documented.

If clothing is discarded because it was cut, bloodied, or soiled, that is documented on the tracking form with two staff signatures attesting that they searched the pockets for valuables. "When a patient states he has lost an item now, we look at the property tracking form and can check whether the bags signed in were received, did the staff search the clothing, and did the patient refuse to lock up items," says Matsuoka.

Since the new system was implemented, the ED’s incidents of valuables and property loss have cut by more than 50%, with fewer than 10 inquiries per month. "We rarely reimburse because of our thorough documentation," says Matsuoka.

[For more information, contact Darlene Matsuoka, RN, BSN, CEN, CCRN, Emergency Department, Harborview Medical Center, Mail Stop 359875, 325 Ninth Ave., Seattle, WA 98104. Telephone: (206) 731-2646. Fax: (206) 731-8671. E-mail: dmatsuok@u.washington.edu.]