CHAPTER ONE

1.0 Introduction
Filing is an act of arranging document in a prescribed order for referral
purpose. Filing is a set of document arranged in prescribed order for convenient,
reference and reservation and this has a medical or particular function which for
health record is to provide an information and retrieval service. Misfiling of
patient record is seen as the inappropriate filing of patient record in health care
delivery system. Filing is the livewire of medical health records form an
essential part of a patient’s present and future health care. As a written
collection of information about a patient’s health and continuing care of the
patient. In addition, medical records are used in the management and planning
of health care facilities and services, for medical research and the production of
health care statistics. Doctors, nurses and other health care professional write up
medical health records so that previous information will be available when the
patient returns to the health care facilities. The medical health record must
therefore be available. This is the job of the medical record worker. If a medical
record cannot be located, the patient may suffer because information which
could be vital for their continuing care is not available. If the medical health
record cannot be produced when needed for patient care the medical record
system is not working properly and confidence in the overall work of the
medical health record service is affected.
Huffman (1994) affirms that the health records is an orderly written
report of the patient complaints, the diagnosis findings, treatment and end result
that in total form clinical picture and when completed provides sufficient
information to clearly identify the patient to justify the diagnosis and treatment,
and to record result. Because “patient forgets but record remembers,” the health
record is of the value to the patient, the hospital, the physician and for research
and teaching. Sequel to the aforementioned, it could be deduced that health
records keeping is the pivot of medicine. Failure to produce patient health
records during his subsequent visits to the hospital by the health records officer

1
due to mislaying and misfiling of patient health records in the health records
department may inflict a lot of problem on the patient, the hospital and the
physician. The continuity of the patient care would be hampered, wrong
diagnosis may be given to the patient, patient may be delayed unnecessarily
before being attended to by the physician, the hospital management will not be
able to review the quality of care rendered to the patient during his stay in the
hospital and the patient relatives may conclude that negligence and malpractice
have been committed during the course of treatment and therefore sue the
hospital management for damages. In order to avoid the above mentioned, the
health records managers/officers should be up and doing in the hospital to make
records of patient available whenever it is needed by the health professionals for
continuity of the treatment.
Yeo (1999) posits that hospitals deal with the life and health of their
patients, good medical care relies on well-trained doctors and nurses and on
high-quality facilities and equipment. Good medical care also relies on good
record keeping, without accurate, comprehensive up-to-date and accessible
patients’ case notes, medical personnel may not offer the best treatment or in
fact may diagnose condition which can have wrong consequences on the part of
the hospitals and the patients. In addition, records also provide evidence of the
hospital accountability for its action and form a key source of data for medical
research, statistical report and health information systems. Nandalal (2013), a
patient health record communicates information about their progress to the
physicians and other health professionals who are providing care to the patient.
It is a communication link among the patient care-givers. For those health
professionals that provide care on subsequent occasions, the medical records
provide critical information such as the history of illnesses and the treatment
given. Also, health records provide evidence that may assist in protecting the
legal interest of the patient, the physician and the health institution.
1. Therefore, we keep health records for a number of reasons:
2. For communication purposes while caring for the patient.

2
3. For continuity of patient care over the course of the patient illness.
4. For evaluation of patient outcome.
5. For medico-legal purposes.
6. For use as a source of health statistics.
7. For research, education and planning.
1.1 Background of the Study
General Hospital Pankshin is a secondary health care institute by Plateau
state Government. The Hospital was established on 7 th March 1975 by His
Excellency Mr. J.D Gomwalk (C.P) Military Governor of then Benue Plateau
and commission by His Excellency, Brigadier M. Usman. The hospital is
located between Trinity Missionary College Pankshin and peace guest house
along Jos road.
The hospital has a total land mass of about 25,000 square metre. The staff
strength of the hospital is 105. Total bed is 11, (76 beds in use and 34 inactive
beds).
The hospital is composed of several units/ department as follows:
1. Administrative department
2. Laboratory department
3. Dental department
4. Nursing department
5. Medical record department
6. Pharmaceutical department
7. Medical department
8. Accounting department
The hospital has five (5) wards namely:
1. Ward 1
2. Ward 2
3. Ward 3
4. Ward 4
5. Maternity ward

3
 Two (2) wards are closed down because of inadequate man power
remaining three (3) wards. The function ward are ward 2, and 3, and maternity
ward.
Ward 2 male pediatric and adult
Ward 3 female pediatric and maternity
The establishment of the hospital was to render secondary health care to
both new and old patients, and also to attend to the referral cases from various
primary healthcares.
1.2 Statement of Problem
Misfiling of patient health records have been a great problem to all health
institutions in Nigeria. To review and evaluate the care rendered to the patients
by the hospital management will be a great problem if the patient health records
cannot be located. Moreover, managerial decision will not be easy without the
patient case note. A lot of delay and loss of valuable cost would be experienced
by the hospital and the patient. Therefore, this study wants to investigate the
causes, consequence and available solution to the problems of misfiling of
patient health records in the health records department.
1.3 Significance of the Study
Health records of patients are an important primary tool in the practice of
medicine. The whole idea behind it is to provide better care of the patient
through careful recording of every detail having to do with the patient illness
and care rendered. Therefore, health records of the patient should be made
available to the health professionals whenever patient visits the hospital for
continuity of their previous treatment. Failure to produce patient health record
by the health information manager/officer in the hospital due to mislaying or
misfiling of such health record will bring about untold hardship on the part of
the hospital and the patient. That is, the health professionals such as the hospital
management physician (doctors), nurses laboratory scientists etc. would not be
able to review the previous treatment and diagnosis given to the patient and
wrong treatment and diagnosis may be given to the patient at the end, which at

4
times may lead to the patient’s death, financial loss on the part of the hospital
and the patient’s relatives may sue the hospital for negligence and malpractice
for damage done to the patient during the cause of the treatment.
1.4 Aim of the Study
To assess the effect of misfiling patient health records in a hospital setting
1.5 Objectives of the Study
i. To examine the available filing and numbering system in health records
department.
ii. To assess the available filing equipment in the health records department.
iii. To assess the types of health records personnel involved in filing and
retrieval of patient health records.
iv. To evaluate the effect of misfiling of patient health records in health
institution.
v. To find solution to the problems of misfiling of patient health records in
the health records department.
1.6 Research Questions
i. What are available filing and numbering systems in the health record
department of General Hospital Pankshin, Plateau State?
ii. What are the various available filing equipments in the health records
department?
iii. What are the types of health records personnel involved in filing and
retrieval of patient health records in the health records department of
General Hospital Pankshin, Plateau State?
iv. What are the effects of misfiling of patient health records in the General
Hospital Pankshin, Plateau State?
v. What are the solutions to the problems of misfiling of patient health
records?

5
1.7 Research Hypothesis
Ho: There is no association between the knowledge of the effects of misfiling
among different professions in the study area (General Hospital Pankshin,
Plateau State).
H1: There is an association between the knowledge of the effects of misfiling
among different professions in the study area (General Hospital Pankshin,
Plateau State).
1.8 Scope of the Study
This study is limited to General Hospital Pankshin, Pankshin Local
Government Areas to ascertain the problems associated with misfiling of
patients case note in the Hospital. Despite the fact that the researcher intended
to broaden the scope of the study but limits it General Hospital Pankshin,
Plateau State due to financial constraint and time factor.

6
 CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter deal with the review of literature which aimed at exploring
theories, concepts and framework related to the factors responsible for misfiling
of patients case note which is based on gaps that identified different framework
which are developed as an innovative method of improving filing system in
health institutions.
There is regeneration in the medical sector which has upgraded the status
of healthcare delivery to a global standard. Most health care centre both public
and private especially the hospital sector, operate the World Health
Organization (WHO) requirements in the health information unit like other units
(Suleiman, 2000).
Aremu (2000) defined filing in health system as a set of documents
arranged in a prescribed order for conveniences reference and preservation.
Filing system in Health Information can be viewed as a process of arrangement
document in prescribed order within a schedule area called library in the
hospital for preservation. Base on the definition, if a file is not properly arrange
in a prescribed order in the library, it will lead to difficulty in retrieval of the file
(folder) of such particular patients, and it will lead to duplication of the records.
In health information keeping, file system is very vital in performing the
function of information services, control information such as location, color,
coding folder tracer system, staff organ supervision safety etc.
According to Anuken (2001), Every unit in the hospital set up therefore is
given outmost in the health care delivery system. However, the medical health
record information unit which suffered negligence in the past, possibly due to
lack of proper appreciation of its numerous relevance especially in the third
world countries, has began to witness and upward consideration by government
and hospital administration. This reconsideration is in view of the relevance of

7
patient’s data and other biostatistical information which is used for planning and
administration of the health care system.
Medical records are kept in the interest of both the patients and clinician.
Proper filing of patients medical decreased patient waiting time at the hospital
and continuing of care (Avorn 2004). Avorn opined analysis is on an
intervention study to address the issue of the consequence of misfiling and
multiple patient folders in a health facility. There is a revelation on direct
factors contributing to insurance of multiple folders, misfiling and its
consequences. An intervention on these consequences and monitoring reduces
acquisition of numerous medical folders for patient and misfiling (Okoronkwo,
2003).
Filing System is a process of arranging document in a prescribed order
within a secluded area ca called Library. In hospital for reservation, security an
convenience for reference purposes and to be located when required. This has a
method or plan of classification to perform and a particular function which
health information provides (Johnson, 2002).
Medical health records form an essential part of a patient’s present and
future health care. As a written collection of information about a patient’s health
and treatment, they are used essentially for the present and continuing care of
the patient. In addition, medical records are used in the management and
planning of health care facilities and services, for medical research and the
productions of health care statistics (Suleiman 2012). It is harder to access the
cost effectiveness of this type of surveillance in a medical records department.
First, medical records are not in open stocks, so they are usually filed by skilled
personnel. The probability of misfiling a record will be considerably lower than
its is in a research library where the patrons often refile books themselves,
second unless a malpractice suit has already been filed in a given case, there is
no clear economic benefit to finding a misplaced folder. The risk manager must
be very forceful in arguing that, even though there is no direct economic gain in
finding a misplaced file the potential loss from litigation is great enough to

8
justify the periodic scanning of the folders (files) to recover misplaced medical
records (Adenatal, 2008).
2.1 Types of Filing System
There are three (3) types of filing system commonly used for file of
patients health information. These include
i. Alphabetical filing system
ii. Numerical filing system
iii. Chronological filing system
Alphabetical Filing System
It is a system in which records are being arranged in an alphabetical order.
Numerical Filing System
It is a system for organizing records through the use of numbers that appear on
the material. Or is system of arranged records by numbers
Chronological Filing System
Are organizing and ordering documents and records in a date sequence or
are arranged in order of their date, day and time
2.2 Responsibility of all Health Centre Staff
These are the duties of all medical record personnel in the hospital or
health centre in terms of rendering care to the patients: Which include the
following
i. Acknowledge and uphold accountabilities and legal obligations relating to
the storage of medical records
ii. Adhere to the guidelines to assist in maintaining confidentiality and
workflow within the health care
iii. The help in examining and maintaining patients document or information
2.3 Types of Medical Records
Electronic Medical Record
Is a digital collection of medical information about a person that is stored on a
computer. An electronic medical record includes information of a patient.

9
Personal Health Record
Is a collection of information about your health and is a document that you are
in charge of one that you compile, update and keep or is a health record where
health data and other information related to the care of a patient is maintained
by the patient.
2.4 Obtaining Supplies for Terminal Digit
Medical record covers are obtained from stores department. Coloured
numbers stickers are available on the remote health stock order form.
A reasonable amount of these supplies should be kept at each health
centre for ongoing creation of medical record as needed.
2.5 Medical Record Numberical Database
To allow for ease of locating medical records filed numerically, as
electronic database providing the clients medical record number, surname, any
order names, and date of birth is required. This database medical records
register was established as part of the medical records standardized project. This
allows for a search using several criteria to identify the client and therefore the
correct medical record.
A hard copy of medical record register is to be maintain for use when it
system are compromised. As in the case of any database, steps must be taken to
protect personal information misuse, loss unauthorized access, modification or
disclosure.
For health centres with Patient Care Information System (PCIS) a final
copy at medical records register should be kept as a reference for accessing
paper based medical record for historical client information as required.
2.6 Types of Filing System Practice in General Hospital Pankshin
The hospital practice straight numerical filing system at the general
outpatient department for filing of treatment and consultative outpatient clinics
for filing of case note and alphabetical filing system for filing of master name
index in the library.

10
2.7 Consequences of Misfiling Between Public Hospital and Private
Hospitals
Consequences of misfiling public hospitals
i. It is time consuming: This occur where there is multiple folder to be filed by
medical staff.
ii. Lost of information for research: this means when a misfiles occur and there
is need to conduct a research on a particular case, the outcomes of the
research will be compete.
iii. Repetition of investigation: This occur when a patient is on admission and
his folder is missing or misfile in which the medical record staff are unable
to have access to the folder, it will lead to repetition of examination about a
particular sickness.
iv. No continuing of patient treatment: This happen when a patient have an
appointment in the hospital and misfile occurs, the physician will not have
idea on previous treatment.
v. Not all staff can retrieve information therefore, there is confidentiality of
information using straight numerical filing system.
Consequences of Misfiling in Private Hospitals
i. None reliability and validity of statistical information on day to day basis
ii. No accuracy in statistical compilation. Because the staff working there are
not medical record professional.
iii. Lost of information for education. If a folder is misfile and there is
information inside the file, there will be no vital facts on the folder.
iv. Lost of information for research
v. Repetition of investigation: Because there is no competent and skilled
personnel/staff
vi. Time consuming
vii. Any literate person can retrieve information using serial unit numbering
system therefore, no confidentiality in the system.

11
 2.8 The Benefits of Good Filing System in Health Care Institutions
i. It enables relevant data and information to be captured in detail
ii. It immense benefits because memory forgets but records remember.
iii. It enables action to be triggered for other necessary patient medical care
iv. It provide evidence for patient having contact with health facility example
road traffic accident (RTA) or level case
v. It contribute greatly toward accurate administration of drugs on patients.
vi. It assist immensely in the area of medical legal purpose
vii. It serves as valuable instrument in the processing of other medical
correspondence.
viii. It helps in claiming of damages in case of litigation
ix. It aid effectiveness and efficiency in patient care and management
x. It provides basis for determining the nature of care given to the patients
xi. Promotes and facilitate communication between patient and other members
of health care team
xii. It helps for proper identification of patient records
xiii. It ensures continuity of patient’s medical care
xiv. Facilitate research activities for the clinicians and others
xv. Gold information informs good decision making professionally or
administratively (Aremu, 2001)
2.9 Factors Contributing to Misfiling of Patient Records
Judith (2012) Doctors learn early in their training the one important and
unavoidable part of their Job is to complete medical records in a timely fashion.
As house staff, their paycheck may be withheld for failing to do so as attending
doctors, they may lose admitting privileges, complete, accurate and up to date
records are critical to patient care, especially since nowadays nearly all records
are kept electronically. Complete records are also an integral part of hospital
accreditation and are important medical legal documents.

12
 When something so necessary is not setting done, it is prudent to explore
what else might be going on. Newly manifested problems could indicate other
serious issues.
DEPRESSION: The physician may be feeling fatigue or a sense of
worthlessness or just be unable to get much done except the most crucial patient
care tasks.
ANXIETY: As charts pile up, a physician can become paralyzed by anxiety so
that they are unable to even begin work on time
STRESS: Almost any issue can preclude the completion of work. Personal
issues such as divorce, illness, financial problems, a malpractice or workplace
conflicts can interfere with work. Many doctors are not willing to openly
discuss such issues with colleagues.
MEDICAL ISSUES: The physician may be struggling with memory issues such
as those caused by early dementia or a condition such as multiple sclerosis,
diabetes or other chronic illness that can diminish strength. To make matters
worse, the physician may try to cover it up.
OVERWORK: Suring a shift, a physician sees patients, orders tests and
prescribes medication, but often what is left for later is the chart work. If the
pace of a practice is ill suited for a physician, lack of record keeping may be the
first sign. A physician might be reluctant to admit that they just can’t keep up.
According to Jackquelyn (2014), PHS Clinical Advisory Committee
members, said “A doctor’s response, behavior and attitude when approached
about medical record completion maybe useful in suggesting whether other
issues are involved, such as depression, anxiety, substance abuse, personality
disorders or personal circumstances”.
Most hospital practice have internal mechanisms for addressing
incomplete records. When the problem persist administrators may begin to
“Confront or sanction” the physician often this does not produce results and if
may even make the problem worse.

13
 CHAPTER THREE
Research Methodology
1.0 Research Method
The method for this research finding involves primary source of data
collection, been the method fit for the importance of tracer card in tracing
patient health record in General hospital Pankshin. The data obtain directly from
identified sources are called primary data and are used specifically for the
purpose of the investigation under study.
3.1 Population of the study
The population of the study is to cover the entire General Hospital
Pankshin, and the total number of staff working in General Hospital Pankshin is
93.
3.2 Sample and sampling technique
The sample of the study involved fifty (50) members of staff which were
randomly selected, from different unit male and female of different age groups
within the hospital. The research adopted a simple random sampling which
refers to the method of drawing a portion of a population in such a way that
each member of the population has equal chance of being selected.
3.3 Instrument for Data Collection
The instrument used for data collection is a designed questionnaire which
is al primary method of data collection and was distributed to the various unit of
the hospital. The questionnaire was divided into two. Section "A" indicate
personal data while section "B" indicate or contain a close ended questionnaire
aimed at finding out the importance of tracer card in tracing patient record in the
hospital.
3.4 Administration of the Instrument
The researcher met with the respondent face to face and distributed the
questionnaires to them, and the researcher returned the following day and
retrieved the questionnaires.

14
3.5 Method of Data Analysis
The Chi-square test (X) applies to only discrete data, counted rather than
measured values. It is a test of independence, the idea that one variable is not
affected by or related to another variable. The test is used for comparing
difference between observed and expected (l.e. theoretical) frequencies after an
observation or experiment has been carried out
Put in another way, chi-square distribution can be used in testing the null
hypothesis (Ho) that two variable of classification are independent for instance,
we may be interested that the null hypothesis that secondary school students
gender and carrier choice are independent. If the null hypothesis is true, we will
expect to find the same proportion of student choosing different carriers. We
may also want the null hypothesis that student, performance in mathematics and
Teacher's method teaching are independent. If the null hypothesis is uphold we
could expect to find the same proportion of students falling or passing
Mathematics Irrespective of the method used in teaching the subject. The chi-
square test of independence is applicable in the above situation.
Contingency Table
In the above type of study, the observed data are usually presented in
what is referred to as a contingency table, a contingency table is a table in which
level of one of the variable represent the rows and the level of the other variable
represent the columns. It is referred to as the number of it row (r) and columns
(e). Thus a table with two rows and two columns is regarded as a 2X2 (read as 2
by 2) contingency table. While another one with 3 rows and 4 columns is
referred to as 3X4 (read as 3 by 4) contingency table. Every contingency table
has dimension, in contingency table we name row before columns.
Chi-square is given as follows:
(oi−ei)2
X² = ∑ ei
WHERE
0i = Observed value or frequency

15
ei = Expected value or frequency

ei = CT X¿ RT

WHERE
CT= Column Total
RT= Row Total
GT = Grand Total

16
 CHAPTER FOUR
4.1 DATA ANALYSIS AND PRESENTATION
This chapter is the presentation, interpretation and discussion of results
collected during the course of this work. The purpose of the study is to
investigate the causes, consequence and available solution to the problems of
misfiling of patient health records in the health records department in General
Hospital Pankshin, Plateau State. To achieve this purpose, a total of 80
questionnaires were distributed and 80 were returned meaning 100% response.
4.2 Analysis of Research Questions
Research question one: Do you operate alphabetical filing system for patient
health records in your department?
Table 1
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 2 2.5
NO 78 97.5
TOTAL 80 100

The table above proves that alphabetical filing system is not the adopted for
patient health records in the hospital, as 97.5% of sampled respondents attest to
that.
Research question two: Do you operate straight numerical filing system in
your department?
Table 2
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 79 98.75
NO 1 1.25
TOTAL 80 100

Table 2 indicates that Pankshin General Hospital operate on straight numerical

filing system as 79 out of total sampled population agree while only 1
disagreed.

17
Research question three: Have you ever operated terminal digit filing system
before?
Table 3
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 0 0
NO 80 100
TOTAL 80 100

Table 3 proves that the health facility in the study area does not and have never
operate terminal digital filing system before. 80 respondents representing 100%
attest to this.

Research question four: Are patients’ records properly sorted before filing?
Table 4
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 34 42.5
NO 46 57.5
TOTAL 80 100

Table 4 shows that there is a mixed reaction in the opinion on patients records
properly sorted before filing, the highest respondent of 46 representing 57.5%
of sampled population disagreed to this while 34 respondents representing
42.5% of sampled population agreed.

18
Research question five: Are you satisfied by the filing method adopted by your
department?
Table 5
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 32 40
NO 48 60
TOTAL 80 100

Table 5 poses an outcome that the filing system adopted by the study area is not
satisfiable. As 48 respondents out of the sampled population are not satisfied
while 32 respondents thought otherwise.

Research question six: Do you have steel filing shelves in your department?
Table 6
RESPONSES NUMBER OF RESPONSES PERENTAGE (%)
YES 11 13.75
NO 69 86.25
TOTAL 80 100

From the table above, 11 respondents representing 13.75% of sampled

population agreed that they have steel filing shelves in their department while
the highest no of respondents 69 representing 86.25% disagreed to this
statement.

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Research question seven: Are the numbers of filing shelves adequate?
Table 7
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 1 1.25
NO 79 98.75
TOTAL 80 100

Data from table 7 indicates that 98.75% of sampled respondents (representing

the highest population sampled) disagreed that the number of filing shelves to
be adequate in the study area.

Research question eight: Do you have filing ladders in your health records
library?
Table 8
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 4 5
NO 76 95
TOTAL 80 100

The information from sampled population in table 8 shows that there are no
ladders in their health records library. 95% of the total population disagreed
while only 5% agreed.

20
Research question nine: Do you have sorting shelves in your department?
Table 9
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 56 70
NO 24 30
TOTAL 80 100

Table 9 indicates that there is sorting shelves in the department as 70% agree
while 30%| disagree that there is sorting shelves.

Research question ten: Do you have enough steel filing cabinets in your
department?
Table 10
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 3 3.75
NO 77 96.25
TOTAL 80 100

Records from table 10 shows that there is no enough steel filing cabinet in their
department due to their responses as 77 respondents representing 96.75% of the
population disagreed whereas 3 respondents representing 3.75% agreed to the
statement.

21
Research question eleven: The number of health records officers in your
department are adequate
Table 11
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 7 8.75
NO 73 91.25
TOTAL 80 100

From data in table 11, it was agreed by 7 respondents representing 8.75% that
the number of health record officers in their department are adequate, while 73
representing 91.25% disagreed.

Research question twelve: Health records personnel should fully concentrate

when filing patient health records
Table 12
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 74 92.5
NO 6 7.5
TOTAL 80 100

Data collected from research question 12 shows that health records personnel
should fully concentrate when filing patient health records to avoid misfiling.

22
Research question thirteen: Lightning system in the filing areas would reduce
mislaying and misfiling of patient health records.
Table 13
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 68 85
NO 12 15
TOTAL TOTAL 100

Information gathered from table 13 shows that adequate provision of lightning

system in the filing areas would reduce mislaying and misfiling of patient health
records. This was proved as 68 respondents representing 85% of sampled
population agreed while 12 respondents representing 15% disagreed.

Research question fourteen: There should be effective tracer cards in the

filing areas
Table 14
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 70 87.5
NO 10 12.5
TOTAL 80 100

Data in table 14 shows that it is advisable to make available effective tracer

cards in the filing areas to make it easier for patient to be treated with ease and
promptly.

23
Research question fifteen: Filing environment are conducive for filing and
retrieval of patients’ records in your hospital.
Table 15
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 7 8.75
NO 73 91.25
TOTAL 80 100

Information from sampled population shows that filing environment are not
conducive for filing and retrieval of patients records in the study area. As
respondent who are staff of the study are proved it.

Research question sixteen: Do you think that clinical research activities may
be hampered if patients’ case files are missing?
Table 16
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 79 98.75
NO 1 1.25
TOTAL 80 100

Data gathered from the table above shows that clinical activities can be
hampered if patients case file are missing. As data indicates that 79 respondents
representing 98.75% of the total population agreed to this.

24
Research question seventeen: Do you think that wrong treatment/diagnosis
can be given to a patient’s if is original case notes cannot be found?
Table 17
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 67 83.75
NO 13 16.25
TOTAL 80 100

Information from table 17 indicates that 67 respondents representing 83.75% of

total population agreed that wrong treatment/diagnosis can be given to a patient
if his original case notes cannot be found. While 13 respondents representing
16.25% of sampled population disagreed.

Research question eighteen: Do you think that mislaying and misfiling of

patient records may lead to patient death?
Table 18
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 76 95
NO 4 5
TOTAL 80 100

Information gathered in table 18 indicates that mislaying and misfiling of

patient records may lead to patient death as it will be difficult to know his or her
health history.76 respondents out of total sampled population agree while only 4
respondents disagreed.

25
Research question nineteen: Do you think that mislaying and misfiling of
patient health records can lead to patient delay in the hospital?
Table 19
RESPONSES NUMBER OF RESPONSES PERSENTAGE (%)
YES 77 96.25
NO 3 3.75
TOTAL 80 100

In table 19, research shows that mislaying and misfiling of patient health
records can lead to patient delay in the hospital as 96.25% agreed while only
3.75% disagreed.

Research question twenty: Do you think that hospital can lose valuables cost if
the patient health records cannot be found?
Table 20
RESPONSES NUMBER OF RESPONSES PERSENTAGE %
YES 58 72.5
NO 22 27.5
TOTAL 80 100

Table 20 above shows that hospital can loose valuable if patients records are not
properly kept. This was proved as 72.5% of sampled respondents agreed while
only 27.5% respondents disagreed.

26
Solution to the problems of misfiling and misfiling of patients’ health
records
Table 21
S/N Solution to the problems of mislaying SA A N D SD
and misfiling of patients’ health records
1 Sorting of case notes before being filed can 56 20 1 2 1
reduce mislaying and misfiling of patient
health records

2 Access to the filing area should be 61 18 1 0 0

restricted to only health records
professional to reduce mislaying and
misfiling of records?
3 Regular training of staff will reduce 27 51 2 0 0
misfiling of records
4 Good tracer system will reduce mislaying 31 46 1 1 1
and misfiling of patients’ health records
5 Computerization of patients’ health records 23 54 0 3 0
is a lasting solution to missing patients’
case files

5+4 +3+2+1 15
Criterion score = 5
= 5 = 3.0

Frequency distribution table for respondents on the solution to the problems

of mislaying and misfiling of patient’s health records:
1. Sorting of case notes before being filed can reduce mislaying and misfiling
of patient health records
Table 22
Score (X) F FX
1 1 1
2 2 4
3 1 3
4 20 80
5 56 280
Total ∑ f =80 ∑ FX=368

27
Mean score = X =
∑ FX = 368 = 4.6 X = 4.6
n 80

The table above shows that Sorting of case notes before being filed can reduce
mislaying and misfiling of patient health records, with mean 4.6 is greater than
3.0 which is the criterion score.

2. Access to the filing area should be restricted to only health records

professional to reduce mislaying and misfiling of records?
Table 23
Score (X) F FX
1 0 0
2 0 0
3 1 3
4 18 72
5 61 305
Total ∑ f =80 ∑ FX=380

Mean score = X =
∑ FX = 380 = 4.75 X = 4.75
n 80

Table 23 shows that Access to the filing area should be restricted to only
health records professional to reduce mislaying and misfiling of records. Since
the mean is 4.75 which is greater than 3.0

3. Regular training of staff will reduce misfiling of records

Table 24
Score (X) F FX
1 0 0
2 0 0
3 2 6
4 51 204
5 27 135

28
 Total ∑ f =80 ∑ FX=339

Mean score = X =
∑ FX = 339 = 4.24 X = 4.24
n 80

The table above indicates that regular training of staff will reduce
misfiling of records. With the mean as 4.24 that is greater than 3.0.

4. Good tracer system will reduce mislaying and misfiling of patients’ health
records.
Table 25
Score (X) F FX
1 1 1
2 1 1
3 1 3
4 46 184
5 31 155
Total ∑ f =80 ∑ FX=344

Mean score = X =
∑ FX = 344 = 4.3 X = 4.3
n 80

Table 25 proved that Good tracer system will reduce mislaying and
misfiling of patients’ health records. With the mean of 4.3 that is greater than
3.0.

5. Computerization of patients’ health records is a lasting solution to missing

patients’ case files
Table 26
Score (X) F FX
1 0 0
2 3 6
3 0 0
4 54 216

29
 5 23 115
Total ∑ f =80 ∑ FX=337

Mean score = X =
∑ FX = 337 = 4.2 X = 4.2
n 80

Table 26 shows that computerisation of patient’s health records is a

lasting solution to missing patients case file as 4.2 mean is greater than 3.0 so
we accept the statement.

30
 CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSION AND
RECOMMENDATIONS
5.0 Introduction
This study was undertaken to investigate the causes, consequence and
available solution to the effect of misfiling of patient health records in the health
records department of Pankshin General Hospital, Plateau State.
5.1 Summary of findings
From the analysis of findings so far, the study area does not use
alphabetical filing system nor have they ever operated terminal digital filing
system, but rather they use the straight numerical filing system in their
department. It was also discovered that, there is no proper sorting of patients
records before filing which means the method employed is not satisfactory. It
was also revealed that durable steel filing shelves are not the method of filing
system they use which is grossly inadequate. One good thing about the filing
system that was attested by the respondents is that, they have sorting shelve
department.
The study also revealed that, there is inadequate number of health record
officers, and was advised to fully concentrate when filing patient health records.
It was agreed upon to make provision for lightning system in the filing area to
reduce mislaying and misfiling of patient’s health records. Suggestion was
made to produce effective tracer cards in the filing area to ease location of
patients record. Data gathered, also revealed that clinical research activities may
be hampered if patients case file are missing which could lead to wrong
treatment or diagnosis given to the patient if his original case note is missing.
This study uncovered that mislaying and misfiling of patient’s record may
lead to death as no health history to aid continuity. The hospital may lose
income, revenue generation and value to the general public and will be termed
as gross misconduct of professionality, lack of organize system of operation and

31
improper record keeping, therefore reducing the quality of health care services
being rendered.
5.2 Conclusion
The result of the study revealed that mislaying and misfiling of patient
health records will have negative effects on patients and hospitals as majority of
respondents in the hospital selected (the health records department in General
Hospital Pankshin, Plateau State) attested to this fact and this has clearly shown
that the hospital can only be rated high in performance when there is prompt
availability of patient’s health records in the clinic for continuity of patient care.
Moreover, high quality service delivery of any health institution can only
be measured with prompt availability of patients’ health records to the
authorized and legitimate users.
The study has clearly shown that there was solution to the problems of
mislaying and misfiling of patient health records in the health records’
department of the two hospitals under review (the health records department in
General Hospital Pankshin, Plateau State).
It was further revealed that if all necessary qualified personnel and
functional working tools are provided, then misfiling and mislaying of patient
records would be eliminated or greatly reduced.
5.3 Recommendations
In view of the significant and negative effects that mislaying and
misfiling of patient’s health records have on patient and hospitals, the following
recommendations are hereby made:
1. All health institutions should be mandated to employ qualified and trained
Health Information Managers to man the department of Health Information
Management so that their knowledge in management of patients’ health
records will assist in reducing mislaying and misfiling of patient health
records.
2. The management of the hospitals should be informed of their
responsibilities in providing space, adequate filing equipment and suitable

32
 filing environment for health records department because the above-
mentioned factors contribute to mislaying and misfiling of patient’s health
records in health institutions.
3. Health Information Managers should maintain high level of decorum and
concentration when filing patients’ record in the health records library.
4. Good tracer system should be put in place by Health Records Officers in
order to track the movements of patients’ case notes in the hospital.
5. Patients’ health records should be computerized to aid quick and timely
retrieval of patients’ information.
5.4 Suggestion for Further Studies
The researcher suggest for similar research work to be carried out in
different local government towards identifying problems responsible for
misfiling of patients case note.

33
 References

Afuye, A.K. (1999). Human Health Infocracy in Democracy Doctrine. Ekiti:

Pan-African Health Information Communications Ltd.

Afuye, A.K. (2001). Strategies and Policies on Release of Patient Information

(1st ed.). Ekiti: Pan-African Health Information Communications Ltd.

AHIMA. (2003). Electronic document management as a component of the

electronic health records. Practice brief. Available online at
www.ahima.org.

AHIMA. (2003). The complete medical records in a hydbrid disclosure.

Practice brief. Available online at www.ohima.org.

Aremu, H.B. (1999). Health Records Management 1 & 11 Ilorin: Decency

printers & sanitation LTD.

Ayilegbe, B.K (2008). Essence of documentation in health care institution,

Kano: Debisco printing press.

Ayilegbe, B.K. (2015). The Dynamics of Patients’ Discharge Summaries. Kano:

Debisco printing press.

Benjamin, B. (1980). Medical Records. Edinburgh: Churchill Livingstone.

Federal Ministry of Health (1996). National Health Information Management

Information System (Health Facility Summary Forms). Lagos: FMOH
Publication.

Geoffrey, Y. (1999). Managing Hospital Records.London : International Record

Management Trust.

Huffman, E.K. (1994). Health Information Management (10th

Edition).Berwyn:physicians’ Record Company.

Lippincott, W and Wilkins. (2006). Steadman’s Medical Dictionary. Baltimore:

A Wolters Kluwer Health Company.

Murphy, Gretchen, Mary Alice Hanken, and Kathleen Waters. (1999).

Electronic Health Records: Changing the vision. W.B. Saunders
Company.
Osundina, K.S. (2004). Principles and Practice of Health Records Management.
Ilesa: K.S. Osundina Publications.
W.H.O. (1983). Guidelines for Medical Records Practice W.H.O. Publication
34
 Appendix

Letter of Introduction

School of Health Information

Management and Biostatistics,
Plateau State College of Health
Technology, Pankshin.
P.M.B. 013 Pankshin.
Plateau State.
15th September, 2023.
Dear Respondent,

I am a final year student of the above-mentioned institution, embarking

on the project topic “The Assessment of the Effect of misfiling in Health

Record Department in General Hospital Pankshin, Plateau State”.

I am solidity for your assistance for the answering of all the questions

contain in this questionnaire. The information given will be treated confidential

and for my academic purpose only.

I count on your cooperation in completing the questions presented below.

Yours sincerely

JACOB JENNIFER

(Researcher)

35
 SECTION A
i. SEX: (a) Female [ ] b) Male [ ]
ii. QUALIFICATION: a) SSCE [ ] b) Diploma/Technician [ ] c) Degree [ ] d)
Others [ ]
iii. RELIGION: a) Christianity [ ] b) Islam [ ] c) Traditional worshiper [ ]
iv. AGE: a) 20-30 [ ] b) 31-40 [ ] c) 41-50 [ ] d) 51and above [ ]
v. DEPARTMENT: a) Nursing and Medicals Personnel [ ] b) Attendant and
Health Record [ ] c) Medical Laboratory [ ] d) Pharmacy [ ] e)
Administration, Technical and Accounting [ ]

SECTION B
Available Filing and Numbering System in Health Records Department
S/NO Filing and numbering system in health records YES NO
department

1 Do you operate alphabetical filing system for patient

health records in your department?
2 Do you operate straight numerical filing system in your
department?
3 Have you ever operated terminal digit filing system
before?
4 Are patients’ records properly sorted before filing?
5 Are you satisfied by the filing method adopted by your
department?

Available Filing Equipment in Health Records Department

S/NO Filing Equipment in Health Records Department YES NO
6 Do you have steel filing shelves in your department?

7 Are the numbers of filing shelves adequate?

8 Do you have filing ladders in your health records

library?

9 Do you have sorting shelves in your department?

10 Do you have enough steel filing cabinets in your

department?

36
Types of Health Record Personnel and Filing Environment
S/NO Types of Health Record Personnel and Filing YES NO
Environment
11 The number of health records officers in your
department are adequate

12 Health records personnel should fully concentrate when

filing patient health records.
13 Lightning system in the filing areas would reduce
mislaying and misfiling of patient health records.
14 There should the effective tracer cards in the filing
areas

15 Filing environment are conducive for filing and

retrieval of patients’ records in your hospital.

Effect of mislaying and misfiling of patient Records

S/NO Effect of mislaying and misfiling of patient Records YES NO
16 Do you think that clinical research activities may be
hampered if patients’ case files are missing?

17 Do you think that wrong treatment/diagnosis can be

given to a patient’s if is original case notes cannot be
found?

18 Do you think that mislaying and misfiling of patient

records may lead to patient death?

19 Do you think that mislaying and misfiling of patient

health records can lead to patient delay in the hospital?

20 Do you think that hospital can lose valuables cost if the

patient health records cannot be found?

37
 Solution to the problems of mislaying and misfiling of patients’ health
records
S/NO Solution to the problems of mislaying and SA A N D SD
misfiling of patients’ health records
1 Sorting of case notes before being filed can reduce
mislaying and misfiling of patient health records

2 Access to the filing area should be restricted to only

health records professional to reduce mislaying and
misfiling of records?
3 Regular training of staff will reduce misfiling of
records
4 Good tracer system will reduce mislaying and
misfiling of patients’ health records
5 Computerization of patients’ health records is a
lasting solution to missing patients’ case files

1.8 Operational Definitions of key Terms

I. Statistics: is the science that is concerned with the collection, organization,
presentation, analysis, and interpretation of numerical statement of facts,
such that the degrees of uncertainty in the conclusion drawn from the data
are minimized as access.
II. Analysis: WHO, (2009) stated that is the detailed examination of the
elements.
III. Misfiling: file (a document) in the wrong place.
IV. Problem: a matter or situation regarded as unwelcome or harmful and
needing to be dealt with and overcome.
V. Hospital: Wikipedia, (2015) defined hospital as a health care institution
providing medical and allied service to people with specialized staff and
equipment that is best known.
VI. Disease: is any abnormal condition
VII. Patient: is a receiving medical services
VIII. Patient Case Note: Case notes contain a surprising number of documents
relating to patient care, as well as pro-forma record sheets and patient-doctor

38
correspondence, they can also include lab reports, X-rays, photographs and
other visual representations.

39