Lost, misplaced or missing patient items can present a stressful and potentially costly situation for patients and families as well as health care organizations. Although provision of care is the primary mission of most health care organizations, functions such as managing patients’ items are one of many necessary tasks. Quantifying costs related to lost items is difficult, as often data is scarce or inconsistent. In addition to the financial implications, losing possessions can diminish the patient experience.
Accountability for managing reporting, investigating and resolving lost or missing patient property varies among organizations. Approaches differ among risk, security, finance and patient experience departments.
Loss consequences
Irrespective of where the process is managed, risks associated with missing items exist across several enterprise risk domains. Such losses may result in patient, family, and staff dissatisfaction. There may be affects on the patient’s quality of life as well as their mobility and their ability to use their senses. Loss of essential items has been identified as a factor in worsening confusion, disorientation and nutritional status, which could lead to safety events such as falls and can be a barrier to comprehending discussions with providers.
Aside from items that patients might physically require, stress and emotions come into play with loss of sentimental or irreplaceable items. For the organization, there are many risks, including staff time spent managing, searching for and storing lost items; the potential cost of reimbursement or replacement; and reputational risk related to the loss of patient confidence.
Many organizations specify that they do not take responsibility for patients’ items. However, communication of this message to patients, families and staff may be vague, inconsistent or disregarded. Patients are often encouraged to leave valuable items at home or turn them over to a friend or family member.
Another common practice is taking inventory with documentation on a list scanned into or completed in the electronic record, which often takes place upon hospital admission, with transfer from the Emergency Department to an inpatient unit, or at the time of discharge, or transfer out the hospital. Because many organizations deny responsibility for patient items, some have stopped routine inventory. Exceptions are made when the patient is unaccompanied or lacks capacity.
Challenges created
Challenges in the property chain are created when policies lack definitions of belongings, valuables and contraband, resulting in the absence of common understanding. Standardizing terminology and defining boundaries for essential items, belongings, valuables and contraband is necessary to avoid misunderstandings. Some organizations have adopted definitions for these terms, which help with policy development. Essential items often are defined as personal articles such as eyeglasses, contact lenses, hearing aids and dentures. Valuables typically include wallets, cash, credit cards and jewelry. Contraband is a general term used to describe items that are prohibited in a particular setting. The definition may vary with the setting such as with the care of patients who are at risk for self-harm.
There are additional process challenges related to paper versus electronic documentation, and variations with responsibility and accountability at the individual and departmental levels. Hospital staff members do their best to manage this process. Clinical staff is understandably preoccupied with patient care, which can make management of these items a lower priority. Problems occur when staff members fail to comply with the policy or process. If inventory is required and not done according to policy, claims can be made for items that were mishandled. Responding to patient complaints about lost items along with investigating, searching and determining liability is time consuming.
There is often confusion regarding departmental responsibility for managing patients’ items. Several departments might have a hand in the process, including clinical departments; outpatient diagnostic and surgical departments; admitting/registration; security; and environmental services (EVS). There may be different methods for documentation, securing items, storage and the length of time items are retained. It is not uncommon for each department to have its own unique off-the-record procedure for management and storage of items, resulting in additional exposure. Aside from patient care units, found items often land in the security department, where they are logged and retained for unspecified but extended periods. Items found by EVS staff after patient discharge might be held in the EVS department or in patient care unit storage rooms.
Patient claims
Individuals might make claims for items they believe they brought with them and some may fabricate claims about costly items that were never brought into the care setting. Use of an inventory list may give the false impression that the organization is taking responsibility for the listed items. Movement of patients through various hospital departments creates further obstacles. There is often no mechanism for accounting at various junctures of care. At some point, the expected process for management of patient items may break down, become impossible to execute or is simply not followed. This results in difficulty when trying to assert the organization is not responsible.
Categorizing all items in one reimbursable or non-reimbursable category should be avoided, leaving room for individual judgment (e.g., “We never reimburse for lost jewelry.”). While it might be easier to deny reimbursement for a missing necklace for which the patient accepted responsibility, the picture is less clear when it comes to essential sensory items needed for daily functioning. Chain of custody of the property is another factor that affects the decision to replace the item, reimburse the patient or deny the request.
Extent of loss problems
Quantifying costs related to lost or missing items is difficult, as reporting and data are often inconsistent and scarce. Reports about missing items might come from individual units, security, risk management, administration or the hospital’s online feedback platform. Reimbursement potentially coming from many sources makes it difficult to quantify and track. Payments may come from different departments within an organization, different categories within a departmental budget, risk or patient experience budgets, or classified as miscellaneous or “other” expenses. This inconsistency leads to a lack of reliable data on the frequency and severity of these losses. Having a centralized method to capture this data is essential for measurement and subsequent improvement.
As with many initiatives, pinpointing a baseline is useful. Identifying data points helps quantify the extent of the problem and monitor the effectiveness of the process. This will involve reviewing and possibly revising how losses are reported and paid (or not) so the measurement is consistent.
A multidisciplinary ad hoc work group that includes key stakeholders, representatives from admitting/registration, emergency department, inpatient units, ancillary departments, security, environmental services and risk management could review the process. The group would identify concerns and vulnerabilities, discuss possible solutions, evaluate the effectiveness of current process, and consider alternative methods.
Establishing a process
- Use a comprehensive “Management of Patient Belongings Self-Assessment Checklist” such as can be found at this site.
- Review current policies; revise as needed.
- Assess current processes in various departments.
- Develop and adopt definitions so there is a common understanding.
- Communicate the policy and process to patients, visitors and staff through staff education, printed materials, website, signage and patient admission forms.
- Strongly discourage patients from bringing or keeping any unnecessary items.
- Document disposition of items indicating patients sent property home, turned them over to a friend or family member, or kept the items and accepted full responsibility, with clear documentation of acceptance or refusal.
- Develop a process for custody and documentation of items belonging to patients who lack capacity, are cognitively impaired, severely injured or not accompanied by a friend or family member, and for management of items following a patient’s death. This would include identifying the department responsible for securing the items and documenting the property transfer to the patient’s representative.
- Implement a process for reporting lost or missing items by educating the staff including front line.
- Ensure tracking, reporting and reimbursement are consistent to better quantify losses.
- Explore alternatives such as bar coding technology; installation of in-room, hotel-type safes; brightly colored belongings bags; and individual patient belonging boxes for essential items such as dentures and hearing aids.
Summary
Missing patient items can affect an otherwise favorable patient experience and may result in financial loss for the patient and the organization. While the provision of care is typically the number one priority for health care providers, management of missing items is a necessary task. Developing a fair, reasonable and consistent approach to the management of patient items is essential in ensuring patient satisfaction and mitigating risks across the enterprise.
References
CHPSO (2016, August 11). Lost and Not Found: Common Items that Disrupt a Patient’s Hospital Stay. CHPSO Newsletter. Retrieved from:Lost and Not Found: Common Items that Disrupt a Patient’s Hospital Stay – CHPSO
Mann, J., Doshi, M. (2017). An investigation into denture loss in hospitals in Kent, Surrey and Sussex. Br Dent J 223,435–438. Retrieved from: https://doi.org/10.1038/sj.bdj.2017.728
Tu, Allan. (2014). Tracking Patient Belongings to Decrease Cost. Master’s Projects and Capstones. 72. Retrieved February 2022 from: https://repository.usfca.edu/capstone/72
AuthorNancy Connelly, RN, BA, CPHRM, DFASHRM
Nancy Connelly is a risk management consultant and a member of the health care enterprise risk management team at RCM&D, an independent insurance advisory firm based in Baltimore, Maryland. Her practice is focused on risk and patient safety in acute care, aging services and physician practice settings. An active member of ASHRM, she currently serves on the Education and Content Committee, Forum Task Force and Professional Ethics Committee.
