Exploring the Challenges of Paper-Based Documentation in Clinical and Administrative Departments at Edward Francis Small Teaching Hospital, the Gambia.

Effective records management is essential for quality health care delivery, administrative efficiency, and institutional accountability. Despite global progress toward digital health systems, many health care facilities in low- and middle-income countries continue to rely on paper-based documentation. This study investigated the challenges associated with paper-based documentation within the clinical and administrative departments of the EFSTH in the Gambia. A qualitative descriptive cross-sectional study design was employed. Primary data were collected across all hospital departments using structured visual inspections and face-to-face interviews with Heads of Departments (HoDs), who were purposively selected based on their managerial roles and experience with records management. An inspection checklist was used to assess the availability of digital infrastructure, storage capacity, documentation practices, and the safety and security of patient data. The qualitative inquiry was guided by a standardized interview schedule. Interview data were analyzed thematically and triangulated with observational findings. The study revealed significant challenges associated with the continued use of paper-based records, such as high volumes of manual documentation, inadequate storage space, lack of secure filing infrastructure, and absence of designated records personnel. These challenges contributed to the frequent loss, misplacement, and damage of patient records, delayed information retrieval, and disruption of clinical and administrative workflows. Poor documentation practices, such as illegible handwriting, incomplete entries, and inconsistent record-keeping, further undermined communication, collaboration, and clinical decision-making, increasing the risk of medical errors. Patient confidentiality and data security concerns were evident due to unrestricted access and insufficient physical safeguards. The paper-based systems increased staff workload, delay reporting, and reduce the time available for direct patient care. The findings highlight the inadequacy of paper-based documentation systems in meeting a tertiary and teaching hospital’s operational demands. The study recommends strengthening records governance, investing in secure storage infrastructure, designating and training records personnel, streamlining procurement processes, and gradually transitioning to an EHR system to improve efficiency, patient safety, and overall healthcare outcomes at EFSTH.