The problem with problem lists

What role do problem lists play in the continuity of patient care?

What a waste of time. A thought that many healthcare professionals have when re-entering a patient’s past medical history.

It’s not exactly what we sign up for as healthcare professionals, manually copying over the past history from a previous entry – which was most likely copied from the entry before that. While managing patient problem lists can be frustrating, overwhelming and often inaccurate, it is a critical aspect of patient care. For patients such as those living with complex health conditions, their medical record may be long and detailed, making it very time-consuming for a clinician to read through it all in an emergency.

What is a problem list?

A problem list is intended to be a reconciled, living, quick reference tool with crucial information about a patient’s health that informs clinical decision making in multi-disciplinary care teams. Displaying a patient’s major health problems helps healthcare professionals determine the best care for them and enables continuity of patient care.

There is currently a lack of standards for the structure and use of a problem list within an electronic health record. This results in a varied approach of what is to be included in the problem list, meaning significant problems can be missed out, or minor problems can end up cluttering the list.

Why is a problem list required?

Healthcare professionals want one centralised, accessible and reliable place where they can quickly understand a new patient’s medical history by looking at their significant problems. A problem list ultimately supports the thought process behind the clinical considerations that need to be made when caring for a patient – what are the most important things they need to think about for this patient?

If a new patient is admitted to hospital who has a known severe allergy to penicillin that is undocumented, this should be recorded in the patient’s problem list. If not, it needs to be communicated and quickly and easily added to ensure the rest of the Multi-Disciplinary Team (MDT) are made aware of this allergy.

Allergies, amongst other health problems, have a significant effect on how a clinician decides on the best care for that patient. As you can imagine, if things are missed off this list and the treatment that is given is not appropriate, it could have a very harmful effect on the patient. To avoid this happening and to ensure patient safety, an electronic platform for the problem list to sit on with established standards is crucial.

How are problem lists best used?

Many healthcare organisations using electronic health records are transitioning from using free-text expressions to standardised, encoded problem lists. The complexity of electronic problem lists is something not easily solved, as there are many considerations that need to be made. These will be discussed in the next series of our blog.