ࡱ> ~{ #Bbjbjzz .h7%` j vvv8V0t  ",,,j0l0l0l0l0l0l0$_25z0v"""0vv,,0p&p&p&"v,v,j0p&"j0p&p&:+,R,,0;8$+ V0000,R5%5R,5vR,$+>p&i5w00&X0""""5 &: Exeter Partnership NHS Trust Records Progress Report 1 Dr Nicole Baur The following report provides a summary of the activities I have carried out in the Exeter Partnership NHS Trust Records project during the time period from 08 January 2007 to 09 February 2007. Apart from the work I have already accomplished, it lists also ongoing and remaining tasks that need to be completed until the end of the project on 07 April 2007. Background On 08 January 2007 I took up work at the Centre for Medical History (CMH) in the above named project, which is carried out in collaboration with the Devon Record Office (DRO). Project team members are Project Leader Jo Melling (JM), County Archivist John Draisey (JD), Outreach Officer Mary Carter (MC) and Associate Research Fellow Nicole Baur (NB). The objective of the three-month project is to develop a model for sampling and preserving data held in a collection of several thousand individual patient records dating from the late 19th century to the 1970s, which has been earmarked for discarding by the Devon Partnership NHS Trust. The collection is temporarily stored at the Devon Record Office, and saving the data electronically will make it accessible to academic researchers and the wider public. As communication is a vital element of effective collaboration, it has been agreed to stay in touch by email, deliver progress reports in four-week-intervals and hold monthly meetings for all project members. These take place by turns at the CMH and the DRO, serve to discuss achievements and problems, and to decide on a strategy for future work. In addition, these team meetings are meant to set activities and time frames for various stages of the project. The first stage of this project, which is covered by this report, can be divided into several phases: Preliminary Assessment of HICs in order to learn about information available, method of storage, and potential links to the patient files Selection of the earliest 300 to 400 HICs for a more detailed investigation Building up a database of these early files Later stages of the project will be concerned with the assessment of the actual patient files and the decision which ones to keep as well as with the digitisation of a sample of the most interesting files. Progress summary Work completed (in the first stage of the project) During the week that commenced on 08 January 2007 all administrative and organisational processes were completed. I received a University Card that allows me access to my office at any time as well as access to the Main University Library. I also obtained a SmartCard to access the DRO at times when it is not open to public. At the DRO I have been given full access to all project data held in the strongroom, which eliminates waiting times for data to be delivered. Computer and internet access, essential for any project involving several parties, is available from my office on campus as well as through public access computers at the DRO. In addition, the CMH provided a laptop equipped with MS Office programmes. The Medical History Research Room (MHRR) at the DRO equipped with a shelf, desk & chair, two additional tables for files and HICs and a telephone was set up from Monday 15 January 2007. All project data can be inspected in the MHRR. The room is locked overnight, i.e. the data can be left there, which is important given the tight time frame of the project. In addition to the room equipment, the DRO provided a variety of reference books and (interactive) maps to complement the information given on the HICs and patient files. In a meeting between JM, MC and NB on 11 January 2007 it was decided to start with a preliminary assessment of the Hospital Index Cards (HICs), as a brief look had revealed that there are several different types of HICs. The idea was to assess the HICs for their physical quality and historical importance. An initial summary of these differences was presented in our first project meeting on 18 January 2007. After more research into what turned out to be three sets of HICs (two from Exminster Hospital and one from Wonford House) I gathered detailed information on the design of the HICs and their changes over the years. The investigation has revealed that the General Reference Numbers on the cards are the key to the patient files. All findings were written down in a report and circulated by email to all project members on 03 February 2007. The report, however, does not include some particularities of the Wonford House HICs, as their investigation had not been finished by the time the report was produced. The most important new finding is that the Wonford House HICs have been either filled in retrospectively or, more likely, copied from some kind of other source. Indicators leading to this conclusion are the use of yellow (Y2) type HICs for patients hospitalised in the 1920s, although these HICs dont seem to have been used prior to 1963. Another hint is the phrase no number on card stated on several HICs. Although the General Reference Numbers on Wonford House HICs seem to follow an ascending system according to the years of admission, there are several irregularities (e.g. patients number 2305 & 4130 were both admitted in 1928, whereas patient number 213 was admitted in 1922 and patient number 124 in 1929). When I encountered the first few of these inconsistencies I regarded them as mistakes that had happened when the cards were copied. However, the great number of irregularities discards this idea. Instead, they might refer to patients who were transferred to Wonford from other hospitals but to answer this question a more detailed investigation into the origin of the Wonford House HICs is required. If the team decides to keep the HICs for future research purposes, it might facilitate work if the three sets could be re-organised and re-labelled according to the following system: Set 1: Exminster Hospital (admissions up to 1949 inclusive) Set 2: Exminster Hospital (admissions from 1950 1970s) Set 3: Wonford House Hospital Following the decision made in the first project team meeting on 18 January 2007 I started a detailed search for the 300 to 400 earliest HICs. This task involved checking all the cards for their admission dates. As the team had also agreed to use these early records to start building up an MS ACCESS database (Version 2000 was available on the project laptop), I designed a database according to the fields we had agreed on in the meeting. As we assumed that most of the HICs would date from the 1930s to the 1960s I set the time frame up to 1944 inclusive. When I had gone about half way through the first set of HICs I realised that this would be too long a time period, but I continued using the set time frame because I thought this information might be useful for future research. I fed a total of 1,742 records into the computer, of which 647 were Wonford House patients. The records relate to time periods as follows: Five-year intervalsNumber of records (Wonford House)up to 18741 (1W)1875 18791 (1W)1880 18843 (3W)1885 18892 (1W)1890 18944 (3W)1895 18998 (4W)1900 190422 (9W)1905 190921 (4W)1910 191462 (19W)1915 191984 (19W)1920 1924110 (19W)1925 1929218 (82W)1930 1934324 (128W)1935 1939413 (170W)1940 - 1944468 (183W)unknown1 (1W)Total1742 (647W) Although a thorough analysis of the data is still to be carried out, an investigation into the HICs and the creation of the database revealed some general patterns, as well as some peculiarities. Wonford House, for example, had a considerable number of outpatients (which have not been included into the database), and inpatients tended to be hospitalised for a shorter time period than in Exminster Hospital. In the given sample the majority of patients treated were women (1088). Man made up for 648 patients, and the sex of six patients remains unknown, as the relevant field on the HIC was not ringed and only the initials of first and middle names were given. Most patients were adults, seven were children under the age of ten, 22 between eleven and 17 years, and 118 patients (from Wonford House) were of unknown age. For 1,290 patients information about the marital state was available, and the majority (907) were single, 303 married, 73 widowed (of them 65 were women), 6 judicially separated and 1 divorced. As far as the confession is concerned, 836 out of 1101 patients were members of the Church of England, followed by 156 Non-Congregationalists and 31 Roman Catholics. Three people claimed to have no religion at all and in 36 cases the religion remained unknown. One of the peculiarities I came across is the regional origin of the patients. Most patients came from Devon; however, the sample includes patients from Buckinghamshire, Cambridgeshire, Dorset, Gloucestershire, Hampshire, Kent, Lancashire, Leicestershire, the former county of London, Somerset, Surrey, Sussex and the West Midlands. Several patients listed Ireland, Scotland, Wales, and even Washington (U.S.) as their home addresses. As the HICs dont give any hints as to why these people had come to Exeter (e.g. members of the army), this raises the interesting question of the catchment area of the hospital. Why would a county hospital accept patients from all over the country, even from outside the country? Were the Devon hospitals known for some particular treatment? The database was completed by Wednesday, 07 February 2007, when I had gone all three sets of HICs. However, it needs to be cut down to the agreed number of 300 to 400 patients. I therefore suggest we split it into two parts (1870 1929 and 1930 1944) and work with the first part only for the moment. If we decide not to include the Wonford House patients, it might be advisable to extend our working table to 1934. Problems encountered To date I have encountered a few minor problems, and staff at both the university and the DRO have been very helpful in dealing with them. HICs There are still a few gaps in certain records in the database because the relevant field on the HIC was either abbreviated or illegible due to the physicians handwriting rather than the age of the HICs. Hopefully, these gaps can be bridged during the next few days with the help of admission registers and case books. They concern mainly diagnoses and addresses. So far, a medical dictionary borrowed from the University Main Library (Butterworths Medical Dictionary, 1978), as well as an interactive map of Devon provided by the DRO has proven very useful, but couldnt clarify all the problems. On several HICs information concerning the patients residence is incomplete and / or unclear. Crownhill, for example, has been put down as a town as well as an additional part of the address (quarter of a town or name of a house?). As all attempts to search for it on the map were to no avail, it might need further investigation on the internet. As I have experienced during my PhD project, working out addresses, i.e. looking them up on the internet or Electoral Registers if available is a very cumbersome process and takes up a lot of time. It might be worth the effort, however, if this information will be used at some later point of time, e.g. to map the hospitals catchment area or locate patients within a particular city. In addition to this, the reference system of the Wonford HICs is still in need of further investigation, as has been outlined above. Computing problems Hardware: A computer breakdown interrupted work on Tuesday morning, 06 February 2007, after about two hours of work. Fortunately, the laptop could be fixed by the University IT staff the same evening, and work continued the next morning. Software: The original idea of splitting the database in several small tables, which contain only certain bits of information (e.g. contact details, personal details, admission information, etc.) and are linked with each other, has not worked out yet. If we continue adding to the database, it might be recommendable to contact Robert Turner for further advice on how to make this database most effective for later research queries. Current work During the week commencing on Monday 12 February 2007 I am going to try to fill in the gaps in the database with information gathered from admission and death registers. There are also casebooks available at the DRO (Exe Vale from 1854, Digby 1886, Wonford House 1873), which might be a fruitful source of information on some of our patients. I am meeting JD on Tuesday 13 February 2007 to obtain full information about any additional registers that might prove useful in completing the database. Work remaining (in the first stage of the project) Although the first stage of the project is almost completed, a few tasks remain to be done. They are in the following order: (1) find the files for the Wonford House patients and try to collect the missing information to complete the database (or, if we cant find anything, delete these files from the database). This task can be started on Monday 12 February 2007 with a new intern at the DRO who is going to help shifting the records and sorting them according to the reference numbers. (2) cleanse the database (i.e. check for spelling mistakes and, if desired, complete addresses) (3) try to answer open questions: When / why did the system of General Reference Numbers in Exminster change? What happened to the previous index cards when a patient was readmitted (as many of them are not available anymore); Will the missing information be available through the patient files? Where does the information given on the Wonford House HICs have its origin? Overall conclusions The project is coming along well within the set timeline. It has already raised some interesting questions and the data I have looked at so far has considerable research potential. To date I have not come across any major setbacks, nor do I anticipate any in the future that will prevent me from continuing my work and submit the remaining two progress reports on time. Dr Nicole Baur 09 February 2007  Wonford House patients are listed separately in this report because of the little information we currently have about them (names and period of stay in hospital). This problem occurs because most of the Wonford House HICs do not fit into any of the categories described in the report on HICs, but are regular white lined index cards copied from some other source. In agreement with JD I have included them into the database, hoping that we can find out more about them through admission and death registers and / or patient files and case books. If we are unable to retrieve the required information, these patients might have to be deleted from the sample.     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