Disaster documentation: improving medical information-sharing in sudden-onset disaster scenarios

Abstract

This study investigates clinical practitioners’ use of medical documentation during sudden-onset disasters in order to better understand how we can improve practice. Thirteen participants, representing nine nationalities and six clinical disciplines (with the collective working experience of at least 15 different organisations providing disaster response), underwent semi-structured interviews using an inductive approach based in grounded theory. The initial codes and themes were analysed over four coding rounds and developed into selective codes. The findings suggest that documentation is overwhelmingly de-prioritised in disasters due to competing demands; there is little incentive to complete documentation at an organisational or government level; practitioners acknowledge the importance of and need for adequate documentation; paper documentation still has its place whilst electronic approaches have both benefits and drawbacks; and disasters require bespoke documentation solutions. Development of the emergency medical team (EMT) ‘data management’ role within EMTs may be one way to focus teams on key areas of improvement.

Keywords:

• Qualitative
• emergency medical teams
• documentation
• disaster

Disclosure statement

No potential conflict of interest was reported by the author.

Acknowledgements

The author would like to thank Professors Fiona Lecky and Tony Redmond, who supported and supervised the PhD study which led to this piece of work. Also, thanks are due to all participants who invested their time in this research study.

Notes

1 GHC, Classification and Minimum Standards.

2 Jafar et al., “Literature Review of Medical Record Keeping”; Kubo, “EMT Minimum Data Set Recommendation.”

3 WHO, “WHO | Emergency Medical Teams”; Jafar et al. “Pilot of a UK Emergency Medical Team.”

4 Al-Awqati, “How to Write a Case Report”; Gillum, “From Papyrus to the Electronic Tablet.”

5 Reiser, “Clinical Record in Medicine Part 2.”

6 Tait, “History of Our Records.”

7 NHS, “Your Health Records.”

8 AMRC, “Clinician’s Guide to Record Standards”; Mann and Williams, “Standards in Medical Record Keeping.”

9 Redmond et al., “Qualitative and Quantitative Study.”

10 McEvoy, “Interviewing Colleagues: Addressing the Issues of Perspective.”

11 Maykut and Morehouse, Beginning Qualitative Research: A Philosophical Approach, 176.

12 Guest, Bunce, and Johnson, “How Many Interviews Are Enough?”; Mason, “Sample Size and Saturation in PhD Studies.”

13 El Hussein, “Using Grounded Theory as a Method”; Glaser and Strauss, Discovery of Grounded Theory.

14 Baker, “Creating Order from Chaos.”

15 Millard, “First, Don’t Be a Tourist”; Brauman, “Global Media and the Myths of Humanitarian Relief.”

16 Clynch and Kellett, “Medical Documentation: Part of the Solution.”

17 Cross, Hero Syndrome.

18 Ammenwerth and Spötl, “Time Needed for Clinical Documentation.”

19 AMC, Good Medical Practice;

GMC, “Duties of a Doctor”;

National Alliance for Physician Competence, Guide to Good Medical Practice – USA;

MCI, Code of Medical Ethics Regulations;

PMDC, Code of Ethics of Practice;

MCHK, Code of Professional Conduct.

20 Oxentenko et al., “Time Spent on Clinical Documentation”; Manor-Shulman et al., “Quantifying the Volume of Documented Clinical Information”; Cheevakasemsook et al., “Study of Nursing Documentation Complexities.”

21 Hall and Walton, “Information Overload within the Health Care System”;

Hripcsak et al., “Use of Electronic Clinical Documentation.”

22 Pandey, “Review of Effectiveness of the Foreign Medical Team.”

23 Lubarsky, “Incentivize Everything, Incentivize Nothing.”

24 Cartwright-Vanzant, “Medical Record Documentation: Legal Aspects.”

25 Kheterpal et al., “Electronic Reminders Improve Procedure Documentation.”

26 Christensen and Larson, “Collaborative Medical Decision Making.”

27 Huston, “Need for Mandatory Clinical Recording Standards.”

28 WHO, “Basic Documents.”

29 Burkle, “Development of Multidisciplinary Core Competencies.”

30 Chackungal et al., “Best Practice Guidelines on Surgical Response.”

31 Hanfling et al., “Legal Issues in Emergencies.”

32 Allen, Methven, and Gosney, “Use of Nutritional Complete Supplements.”

33 Keller and Koenig, “Sources of Stress and Satisfaction in Emergency Practice”;

Adriaenssens et al., “Exploring the Burden of Emergency Care”;

Flowerdew et al., “Teams under Pressure in the Emergency Department.”

34 Gunn, “Health Effects of Earthquakes.”

35 Skelton and Harvey, Rehabilitation in Sudden Onset Disasters.

36 Wuthisuthimethawee et al., “Wound Management in Disaster Settings.”

37 UKEMT, “Data Management.”

38 Read, Taithe, and Mac Ginty, “Data Hubris?”

39 Levy et al., “Application of Information Technology.”

40 Nelson, “Information Management during Mass Casualty Events.”

41 WHO, “EMT-MDS Daily Reporting Form.”

42 Borg, “Pacific Islands Internet Project (PIIP)”;

Shamanna, Nirmalan, and Saravanan, “Roles and Responsibilities”;

Alhamda, “Correlation between Respect, Responsibility.”

43 Krogh, Rough, and Thomley, “Comparison of Two Personal-Computer-Based Mobile Devices.”

44 Krause et al., “Forming an Integrated Documentation System.”

45 Rosenbloom et al., “Data from Clinical Notes.”

46 Hall and Walton, “Information Overload within the Health Care System.”

47 Cheevakasemsook et al., “Study of Nursing Documentation Complexities.”

48 Jafar et al., “Pilot of a UK Emergency Medical Team.”

49 GHC, Classification and Minimum Standards.

50 UKEMT, “Data Management.”

Additional information

Funding

Hong Kong Jockey Club Charities Trust; Royal College of Emergency Medicine.

Notes on contributors

Anisa J. N. Jafar

Anisa J. N. Jafar is a trainee in emergency medicine, having completed her primary medical degree in Manchester in 2008. She has taken a combined clinical and academic route to marry her interests in emergency medicine and global health. She completed a DTM&H (Liverpool) in 2010 and an MPH (Manchester) in 2014 and completed her PhD in 2019 at the HCRI in Manchester, looking at medical documentation in disasters. She intends to continue her clinical training alongside a developing academic interest and enjoys immediately translational research which encompasses changes in practice and policy. She has been fortunate to work closely with the UK EMT (Emergency Medical team) via UK-Med and thus to contribute to the WHO EMT minimum data set working group.