Flippers, Organizers & Page Turners



LNCtips.com: Flippers, Organizers & Page Turners

Are you a Flipper, an Organizer, or a Page Turner? These terms are my way of describing the approaches that legal nurse consultants take as they review medical records. So let's take a look at how - and why - LNCs review medical records the way they do.

Let's start with Flippers.  Flippers identify the allegations and then flip to the chart sections that will prove or disprove the allegations. After that, they'll read the rest of the records to get a more complete picture. For example, if there's an allegation that an Emergency Medicine physician delayed diagnosing a stroke, the Flipper looks at the ER records first, then the history and physical, and then the radiology reports, progress notes and nursing notes for the allegation time period. After that, the Flipper looks at the rest of the chart.  I've noticed that many expert LNCs review medical records like this, as do new legal nurse consultants and those with recent clinical experience. This makes sense because flipping from chart section to chart section is how nurses look up information in the clinical setting.

Contrary to Flippers, Organizers like to review medical records that are sectioned in time sequence order. Organizers don't flip back and forth between sections. Instead, the Organizer starts at the front of medical records and ends at the back.  Using the ER example above, the Organizer looks first at the admission documents, which are the first records in the chart and then the remaining medical records by section. The ER records could be the second section or they could be the last section.  The Organizers I know are very experienced LNCs. Flipping is a quick way to get information but viewing an organized medical record is more efficient and thorough in the long run. That's because the LNC is looking at each page only once. With flipping, there's a possibility of missing some records or reviewing pages more than once.

However, Organizers have difficulty reviewing records unless they're in sections and in chronological order.  Page Turners, on the other hand, review medical records page by page no matter what order they're in. For example, let's say that the records have a few pages of nursing notes from April 2009, then some progress notes, followed by nursing notes from December 2008.  With these records, the Page Turner starts on page one and reviews each page to the end even though they are not in date or section order. LNCs of all experience levels have been forced to become Page Turners, at least part of the time. That's because some medical records are electronic instead of paper. While electronic medical records can be organized, the process is laborious. Most LNCs quickly learn to become Page Turners when working with electronic medical records.

So which type of reviewer are you? Are you a Flipper, an Organizer, or a Page Turner? Or maybe you're like me and use all three methods depending on the circumstances.

...Katy Jones