Counselling concern is to assist in the development of education, social, personal and career or occupational choice. According to Effiom BE [1], Counselling is leaning oriented process carried on by a professionally competent counsellor in relevant psychological skills and knowledge, to assist the client with methods within context of the total personal to learn more about self, accept self, and learn how to put such understanding into effect in relation to more clearly perceived, realistically defined goals to enable client become happier.  Some people will not publicly express their willingness to see a psychotherapist or counsellor and have more to do with understanding of not feeling the need to disclose personal information [2].

Medical records of patients are an important primary tool in the practice of medicine [3]. Asserted that the whole idea behind it is to provide better care of the patient through careful recording of every detail having to do with patient illness and care rendered. Therefore, health records of the patient should be available to the healthcare professional whenever patient visit 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 and misfiling of such health record will bring about untold hardship on the part of the hospital and the patient. Ideally a tracer card is issued at the same time the unit health record is initiated while the patient is still physically present in the hospital for health care, the tracer card is sent to the record and is filled away in the space on the shelf for that case folder [4].

In health records keeping a filing system is very important. A filling system may perform the function of an information service; certain controls are necessary to ensure the where about of the issued document or patient case note. Health record professional who have Knowledge of the intricacies involved in the movement of case folder within the hospital will appreciate that the problems associate with effective controls are from diablo. For this reason, a tracer system is absolutely necessary in any large filing system of the hospital which has multiple users and tracing procedure must be followed every time a file is retrieved.

In deciding upon a suitable tracer system due account must be taken of withdrawal rate of document and the time span during which they are required. To deal with emergency patient, Health record are required at all hours of day or night and maintained 24hours services. Therefore, a tracer system is a system which is introduced into the unit system when a unit health record is initiated, so that the where - about or the movement of patient case note can be easily as curtained. A tracer card is issued at the same time the unit health record is initiated while the patient is still physically present in the hospital for health care; the tracer is sent to the record and is filed away in the space on the shelf for that case folder. When the case folder is retrieved, it is the duty of the health record officer to ensure that the tracer card is put inside the case folder and to record the date of return on the tracer card. It is on this background that the researcher seeks to examine the effective and efficient practice of tracer system in University of Calabar Teaching Hospital.

Research Question

The following research question were formulated to guide the study:

• Is the practice of the tracer system effective at the University of Calabar Teaching Hospital?
• What is the efficient practice of the tracer system at the University of Calabar Teaching Hospital?
• What are the factors hindering the effective and efficient practice of the tracer system at the University of Calabar Teaching Hospital?

Effective Practice of Tracer System

Record tracking is the component of a record management system that ensures the location of records when the need arises.

According to Don (2018), an effective tracer system permits adequate provision of appropriate and safe access to patient health records. By viewing care across the organisation, it allows health care providers to validate consistency, safety, and uniform performance of care, treatment, and service.

Osundima (2005) added that a good tracer system provides control over all the filing systems. In essence, the tracer system is a method used to trace the movement of an individual patient file in the health record division. The movement of any case note going out of the health records department is made known by the tracer system.

Nandala (2013), in the same line of opinion, is of the opinion that 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 the management of patient health records is available.

Moreover, Yeo (2004) affirms that the health records of patients are an important primary tool in the practice of medicine and that there must be an adequate format to track the movement of these records from one place to another to aid safe access to patient health information at all times. The whole idea behind it is to provide better care for the patient through careful monitoring of every detail having to do with the patient's illness and the care rendered. Therefore, the patient's health records should be made available to the health professional whenever the patient visits the hospital to ensure continuity of their previous treatment. Failure to produce patient health records by the health records professionals in the hospital due to mislaying or misfiling of such records will bring about untold hardship on the part of the hospital and the patient. The 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's relatives may conclude that negligence and malpractice have been committed during the course of treatment and therefore be liable to the hospital management for damages.

In order to avoid the above, the health records officer should monitor patient records with the use of a tracer card to make patient records available whenever they are needed by the health professional for continuity of treatment.

The accurate and complete documentation by health information managers assures easy location and availability of patient’s case notes through the effective utilization of tracer cards. The Health Information manager is also expected to prepare in advance before the clinic day all the patient records that have been booked on appointment with the respective consultant and make the case notes of patients ready and available at the clinic for easy access by the consultant in order to facilitate effective treatment of the patients. Without the professional documentation of a health information manager in various specialty clinics.

Don (2018) views a tracer system as a system that is introduced into the unit system when a unit health record is initiated so that the whereabouts or movement of patient case notes can be easily ascertained. Some hospitals prepare individual tracer cards for each case note file, noted with the date and the name of the user, and leave them on the shelf as a substitute. A variation on this is the use of a miniature folder that acts as a tracer and can also be used to store loose documents received in the record department while the file is on loan. However, for many hospitals, these options will be too expensive.

As Indicated in organising and controlling current records, when an item is passed from one borrower to another, the transfer should be recorded on a file movement sheet that is sent to the record department to enable the tracer card or loan book to be updated. Further posits that health information management is the initiation of patient documentation in any hospital. A patient cannot be attended to in abstract, and therefore, there must be an initial documented fact about him that would serve as the basis for the commencement of other healthcare services by other members of the health profession. [4] Affirms that it would be ridiculous to see some patient health records flying about without adequate measures in place for their proper Custody.

Efficient Practice of Tracer Card System

According to Osundina (2009), an efficient tracer system should, by standard, be able to tell the whereabouts of a patient's case note throughout the duration of care. Accurate recording and knowledge of the location of all health records are essential if the information they contain is to be located quickly and efficiently. The tracking system used provides an up-to-date and easily accessible movement history.

Health records are often misplaced or lost because their next destination has not been recorded. It is vital that health records are appropriately retrieved and tracked to ensure they can be located as and when required to assist in the provision of quality care. The procedure of the tracer system is applicable to all health record officers whose responsibilities involve the tracking and retrieval of health records from their current location to a new location, whereby the last recorded person will be held responsible for the recovery of any missing records. Thus, when a health record is removed from its current location to a new location, it is mandatory to track the location of the record.

According to Makata [5], all services will operate and maintain a robust and efficient tracking system. There are currently two types of tracking systems: manually operated tracking systems and electronic tracking systems. A manually operated tracking system entails inserting a tracer card in place of the health record, which is being removed, and stating extensively the following details:

• Patient’s Unique Number.
• Name of the patient.
• Destination contact details of the person, unit, or department to whom the record is being sent
• Signature of the retriever.
• Electronic tracking system.

When an electronic tracking system is operated as part of the clinical information system. Example case note tracking portal, the Following actions must be followed:

• Located the health record that is required.
• Request the health record by selecting the organization and service point that require the health record.
• Dispatch the requested health record to the requested location.
• Receiver of health records to automatically update current location and service point.

According to Khamna [6], the tracer card plays a very vital role in the filing area. Contain the record number, the consultant's name, and the date of retrieval. The cardinal rule in the filing area is that no record can be removed from the shelf without being replaced by a tracer card.

According to Greenfield (2009), the review concludes that despite evidence of the effectiveness and efficiency of patient journey surveys and tracer systems in managing patient information, there is limited evidence of their appropriateness for adequate service delivery in the health care system. Poor tracking of patient health records can cripple health care service delivery, halting efficiency, sucking up previous time, and causing unnecessary stress to the patient and the health care providers. Briathwaite (2007) highlighted the factors affecting the practice of the tracer system in health records management.

Lack of Good policy: A systematic, effective, and efficient tracking of patient records needs a policy. A policy is a statement that serves as a road map to guide the movement of patient case notes from one place to another. Thus, to enhance an effective and efficient patient tracer system, a policy needs to be established so that a framework can be established and that health records professionals will strictly comply with the policy of "a must use of tracer cards "in places where the patient's original folder is removed. According to Effiom BE [7], they must be initiated into the intuitive sensitivity of seeing order in disorder through practice and deep listening.

Limited production of tracer cards: Lack of tracer to put in a place where the patient's original folder is removed is a major factor affecting the effective and efficient practice of the tracer system in health record management. Non-challant attitude towards the use of a tracer card.

Lack of Security: In the filling area which can result to other hospital staff retrieving a patient folder without placing a tracer card.

Tracer cards can be easily misfiled, and records not filled out in any particular order can be difficult to locate when needed. According to Uni [8], records management requires a high degree of skill among professionals. A trained and licenced health record officer has a clear and foolproof method for storing and tracking patient records. However, those who are not trained in proper records management and are responsible for filing patient records could end up with a lot of problems. Patient records as well as tracer cards may get filed in no particular order, or they may follow a confusing or unclear storage method.

Possible Measures to Minimize Factors Militating against Effective and Efficient Practice of Tracer System

According to Braithwaite (2007), solutions to the factors militating against the effective and efficient practice of tracer systems include:

• Implementation of a policy to serve as a guide to the use of the tracer system
• Availability of a tracer card
• Routine education for staff on the right attitude towards the use of the tracer card
• Strict security in the filling area
• Filing and retrieving should be done by health records professionals

The accurate and complete documentation by health information management assures easy location and availability of the patient’s care note through effective Utilising the tracer card, the health information management is also expected to prepare in advance before the clinic days all the patient records that have been booked on appointment with the respective consultant and make the patient's case note ready and available at the clinic for easy access by the consultant in order to facilitate effective treatment of the patient. Without the professional health information manager in various clinics, especially via appointment system, general outpatient clinics.

The research design used for this study was a descriptive research design. The descriptive design was used in analysing the characteristics and phenomena of the study area. This design is considered appropriate because it gives the researcher the opportunity to study a large population through the use of randomization, which allows for generalisation of results based on the sample. The design allows the researcher to use the population for the study by studying the sample and drawing references about the characteristics of the required population. The sample size used for the study was 100 respondents. The sampling technique employed was a complete enumeration method. The stratified random sampling techniques were used for the purpose of achieving the study objectives at the University of Calabar teaching hospital. The questionnaire was ratified as appropriate before it was administered to the respondent. The reliability of the questionnaire was tested using the test method. A visit was made to the school to be used for the study, and permission and assistance were sought from the head of the department of Health records and the staff. It was agreed upon and scheduled on a date that was convenient for all stakeholders concerns.

Presentation of result

Table 1:  Is the Practice of Tracer System Effective In University Of Calabar Teaching Hospital Calabar?

rheological properties of hydrocarbons.

Source:  Field survey; 2022

Result from the table above, which presented the analysis of responses based on the Practice of tracer System Effectiveness in the University of Calabar Teaching Hospital, Calabar. The practice of the tracer system was effective, as 104 (96%) of the respondents practiced the use of the tracer card in the place where the patient's original folder is removed. 100 (92.6%) of respondents said that the tracer card helps track the movement of patient health information. 98 (91%) of the respondents are of the opinion that the use of a tracer card facilitates easy retrieval of patient folders. 102 (94%) of respondents are of the opinion that the practice of the tracer system is effective.

Table 2: What are The Efficient Practice of Tracer System in University of Teaching Hospital, Calabar?

Source: Field Survey; 2022

From Table 2 above, which presented the analysis of responses based on the efficient practice of the tracer system in the University of Calabar Teaching Hospital, Calabar The practice of the tracer system was efficient, as 106 (98%) respondents practice the ability to trace patient folders. 104 (96%) respondent is of opinion that the prevent mislaying of patient case note in health record library. 97(90%) respondent is of opinion to promote unit system of health record. 99 (92%) respondents agreed to reduce patient waiting time in the hospital.

Table 3: What Are the Factors Hindering Effective and Efficient Practice of Tracer System in University of Calabar Teaching Hospital Calabar?

Source: Field Survey, 2022

From Table 3 above, Analysis reveals that Lack of policy Implementation is one of the factors hindering effective and efficient practice of the tracer system at the University of Calabar Teaching Hospital in Calabar; 100 (92.6%) respondents are of the opinion that there is a lack of policy implementation. 102 (94%) respondents agreed to the limited production of tracer cards. 88 (81%) respondents stated the lack of monitoring in filing. 79 (73%) respondents have an opinion on the Durability of the tracer card in the health record system.

Table 4: What Are the Possible Solution to Prevent Factors That Hindering Effective and Efficient Practice of Tracer System in University of Calabar Teaching Hospital Calabar?

Source: Field Survey, 2022

From table 4 above, policy implementation recorded 106 respondents representing 98%, and 108 (100%) respondents have an opinion of the availability of tracer cards. 88 (81%) are of the opinion that ensuring strict security in the filing area 98 (91%) respondents are of the opinion that routine education of staff on the use of tracer cards.

After a careful analysis of the research question based on the topic, findings and results showed that in the respective research question 1, the Practice of tracer System Effectiveness in the University of Calabar Teaching Hospital, Calabar. The practice of the tracer system was effective, as 104 (96%) of the respondents practice the use of the tracer card in the place where the patient's original folder was removed. 100 (92.6%) of respondents said that the tracer card helps track the movement of patient health information. 98 (91%) of the respondents are of the opinion that the use of a tracer card facilitates easy retrieval of patient folder. 102 (94%) of respondents are of the opinion that the practice of the tracer system is effective.

From research Question Two, what is the efficient practice of the tracer system in the University of Calabar Teaching Hospital, Calabar? The practice of the tracer system was efficient, as 106 (98%) respondents practice the ability to trace patient folder. 104 (96%) respondent is of opinion that the prevent mislaying of patient case note in health record library. 97 (90%) respondent are of opinion to promote unit system of health record. 99 (92%) respondents agreed to reduce patient waiting time in the hospital. From research Question Three, Analysis reveals that Lack of policy Implementation is one of the factors hindering the effective and efficient practice of the tracer system at the University of Calabar Teaching Hospital in Calabar; 100 (92.6%) respondents are of the opinion that there is a lack of policy implementation. 102 (94%) respondents agreed to the limited production of tracer cards. 88 (81%) respondents stated the lack of monitoring in filing. 79 (73%) respondents have an opinion on the Durability of the tracer card in the health record system.

Furthermore, from research question four, policy implementation, 106 respondents, representing 98%, and 108 (100%) respondents have an opinion on the availability of tracer cards. 88 (81%) are of the opinion that ensuring strict security in the filing area 98 (91%) respondents are of the opinion that routine education of staff on the use of tracer cards.

In the course of completing this study from the relevant data, the following conclusions were drawn and arrived at: That high degree of lack of policy implementation on the use of tracer cards This is based on the reason that Lack of policy Implementation is one of the factors hindering the effective and efficient practice of the tracer system at the University of Calabar Teaching Hospital in Calabar. It is also noted that the practice of the tracer system was not effective in tracing patient folders at the University of Calabar Teaching Hospital, Calabar. The tracer card helps track the movement of patient health information; the tracer system is gradually losing its value, thereby giving rise to problems of various dimensions. They include placing the patient record in the wrong location as well as not signing out correctly. Based on the data analysed, the availability of a tracer card should be implemented, as should strict security in the filing area. The health record department at the University of Calabar should implement a policy and such training the staff on the use of tracer cards in the hospital.

1. Effiom BE, Ekwok ML, Ebuara MO, Odo-simon K, Elizabeth GA, Anthonia I. Counselling Adult Leaner for Community Participation in Development of Literacy Centre in Akampa Local Government Area of Cross River State, Nigeria. Journal of Humanities and Social Policy. 2022; 8: 17-24.
2. Effiom BE, Oshama EM, Lawrence EM, Ukwekie SI, Obi JN, Agwu UA, et al. Emotional Intelligent, Critical Thinking and Counselling on Mental Health in Calabar South Local Government Area Cross River State, Nigeria. British International Journal of Education and Social Science. 2022; 9: 1-9.
3. Huffman K. Psychology in action (7^th) Hoboken NJ John Wiley & son, Inc. 2004.
4. Ayilegebe BK. Essence of documentation in healthcare institution kano; Debis co, Printing Press. 2008.
5. Makata K, Kinung-Hi S, Hansen C, Ayieko P, Sichalwe S, Mcharo O, et al. Hand hygiene intervention to optimize helimith infection control: Design and baseline result of mikono safi- An onging school-based cluster-randomized controlled trial in NW Tanzian. Plosone. 2020; 15.
6. Khamma (2006) printers against center andru paradushin khamma. 2014.
7. Effiom BE, Cyril A, Odey GA. Inclusive Counselling Education for Entrepreneurial and National Development. International Journal of Education and Evaluation. 2020; 6.
8. Uni Asma, Yusof ZM. Pengurusan rekod elektronic dalam sector awam di Malaysia: pengintegrasian elemen polisi. Tesis Sarjana Teknologi Maklumat, University Kebangsaan Malaysia. 2008.
9. Effiom BE, Arop Lo, Ngwu ME, Obi FB, Ubi GM. Exploiting Genetic Counselling as a tool for the Analysis of dissociative Behavior and Sub-normality from Conception to Birth among Maladjusted Blind, Deaf and Dumb Infants. Annual Research & review in Biology. 2022; 37: 1-14.
10. Effiom BE, Janet P, Ekwok ML, Unimna, Felix U, Ojedor FI. Personal Variables and Awareness of Covid-19 Vaccinations Amongst Secondary School Students in Uyo, Akwa Ibom State, Nigeria. Journal of Survey in Fisheries Sciences. 2023; 10: 4655- 4667.
11. Hashim KF. Pelakasanaan Pengurusan rekod elektronic dalam agensi kerajaan Negeri keda. Laporan penyelidikan jangka pendek, University Utara Malaysia. 2006.
12. Osundia KS. Principle and practice of health record management Ilesa: KS Osundina Publication. 2004.