LNCtips.com: The Mini Index
I love it when I
receive hard copies of medical records that are neatly
numbered or Bates stamped. I
hate it when someone who doesn't know the meaning of
chronological order has organized those numbered or stamped
records. If I
leave the scrambled records in numerical order, I
can't quickly find specific records that I need.
If I put the records in date order, the numbers
are out of sync. Creating a medical chronology
helps, but sometimes you have to look at the hard copies of
these mixed up records. To make it easier, I use a mini index.
I don't create mini indexes for every set of medical records. If the entire record is stamped or numbered, I usually keep it in that order. Also, if the records aren't very important to the case, I usually don't take any action. But for hard copy records that ARE important to the case, I know that the attorney and I will look at those documents repeatedly.
Let's look at an example involving a surgeon's inadvertent transection of the patient's common bile duct during a laparoscopic cholecystectomy. The allegation was that the surgeon failed to timely diagnose the complication resulting in the need for reconstructive surgery. To understand the sequence of medical events in this case, it was important to look at the operative report, progress notes, orders, nursing notes, and radiology reports. All of the records, except for the radiographs, had been organized in reverse chronological order (most recent record first). I didn't create mini indexes for those sections because even though they were backwards, the records were still easy to follow.
The radiographs were a different matter. As you can see from this sample, the radiographs hadn't been organized in any order. For example, two radiographs were performed on May 7, 2011. One radiograph was on the first page and the second one was on page 24. In between were radiographs performed on May 9 through June 2, 2011 as well an MRI from 2012. I left these records as they were numbered, but the mini index provided a quick way to locate each report. I tabbed all of the medical records and placed the mini index behind the X-Ray tab for easy access.
I'm finding these jumbled up records more and more as health care providers convert from handwritten to electronic medical records. Using a mini index provides a quick way for legal nurse consultants to unscramble the records.