M Parvaiz*, GK Singh*, R Hafeez+, H Sharma^
*St.
Richard’s Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE, UK.
+King’s
Mill Hospital, Mansfield Road, Sutton-in-Ashfield, Nottingham NG17 4JL UK.
^Royal Alexandra Hospital, Corsebar Road, Paisley PA2 9PN, UK
E-mail: hksharma1@aol.com
SMJ 2006 51(4): 49
Background and Aims: Abbreviations are commonly used in the medical world
to save time and space whilst writing in the patients’ case notes.
As various specialties have evolved, each has developed a collection of
commonly used abbreviations within its practice, which may not be easily
recognisable to those working as an allied branch. The purpose of this study was
to assess whether we, the multidisciplinary team members, interpret the
abbreviations used in the medical records correctly?
Methods and Results: We analysed orthopaedic inpatient admission case
notes (n = 45) for the use of abbreviations (n = 57) and their appreciation by
different members of the multidisciplinary team (n = 175) by means of a
standardised questionnaire. We found a wide variation in understanding and
interpretation of orthopaedic abbreviations among health care professionals.
Even the orthopaedic surgeons could answer correctly 57.2% only, followed by
physiotherapists (49.9%). Non-orthopaedic groups produced significantly less
number of correct answers than the orthopaedic surgeons (p < 0.019).
Interestingly, nursing and physiotherapy departments produced significantly
fewer mal-interpretations than the orthopaedic surgeons (p < 0.023).
Conclusions: Whilst abbreviations may indeed save time, the use of
confusing abbreviations is unacceptable. We recommend that acronym obsession
should be discouraged in order to reduce possible clinical error.
Keywords:
Orthopaedics, abbreviations, multidisciplinary team.
Abbreviations are thought to simplify and facilitate modern communication.1,2
They are usually not taught as a part of the core curriculum in medical,
nursing, physiotherapy or other specialty courses; and exposure to them is often
postgraduate and extremely varied. Because
of the current specialty-specific practice, many would not recognise
abbreviations in other fields.3 Half of the commonly used
abbreviations in ear, nose and throat surgery have been shown to be unclear to
more than 90% of the junior doctors from other specialties.4 This may
not be a concern during the office hours as staff members are usually available
to provide help and guidance. However,
this may not be the case during out of hours.
It is likely that the staff members, who would previously have been
dealing with their own specialty patients at night, may now be looking after a
broader spectrum of medical and surgical patients, both in the acute and ward
based settings.4,5 In such situations, the only information available
would be from the medical notes, which are of varying quality, both in the
content and legibility.3,6
Abbreviations are commonly used in the medical world to save time and
space whilst writing in the patients’ case notes.7 As various
specialties have evolved, each has developed a collection of commonly used
abbreviations within its practice, which may not be recognisable to those not
working within the same field. The purpose of this study was to assess whether
we, the multidisciplinary team members, interpret the abbreviations used in the
medical records correctly?
We conducted a cross-sectional observational study on the use of
abbreviations (n = 57) in the medical records (a total of 45 orthopaedic
inpatient case notes). The case notes were selected randomly and assessed
prospectively over one-week period for the use of abbreviations. These
abbreviations were then tabulated and circulated as a structured questionnaire
to 175 medical and paramedical staff (Figure
1). The staff members were comprised of orthopaedic surgeons, general
surgeons, A&E physicians, general physicians, ward nurses, theatre nurses,
physiotherapists and occupational therapists; and were comparable in number
(between 20 to 24). The staff members were asked to document their understanding
of these abbreviations. These abbreviations were not shown in context with the
clinical notes as these could help the person in guessing to make out the
answer. There was 100% response rate to the questionnaire, as all these
questionnaires were personally distributed and collected. The correct
orthopaedic meaning of these abbreviations was defined by consultant orthopaedic
surgeon and subsequently used as key answer for comparison and subsequent
analysis. The answers from all 175 staff members were then divided into correct
answers, incorrect answers, different (mal-) interpretations and blank answers. Mal-interpretation was defined as those responses, which did
not correspond with our orthopaedic key answers, but were published as
acceptable abbreviations in a standard reference text.8
Statistical analysis: The answers given by orthopaedic surgeons were
compared with all other different multidisciplinary health professional groups
using Student’s paired t-test. A p value of less than 0.05 was considered to
be statistically significant.
Detailed analysis comparing percentages of all responses amongst different
health professional groups is presented in Table
1.
On analysing the correct answers, orthopaedic surgeons scored maximum, but
remained poor with only 57.2% correct answers. The physiotherapists were the
second highest correct-answer scoring group (49.9%). As shown in Table
2, all other groups produced significantly less number of correct answers
than the orthopaedic surgeons (p < 0.019).
In
mal-interpretations (Table 3),
general physicians (4.5%) scored highest in this category followed by the
accident and emergency physicians (4.2%) and then the orthopaedic surgeons
(3.7%), it was not statistically significant. Interestingly, nursing and
physiotherapy departments produced significantly fewer mal-interpretations than
the orthopaedic surgeons (p < 0.023). Figure
2 compares the averages of mal-interpretations by different groups.
During
analysis of incorrect and blank answers, we found that therapy based specialties
scored maximum incorrect answers (p <0.05) followed by nursing group.
Abbreviations save time,1,7 however, it is vital that the
phrases, which they represent, should be clearly identifiable by everyone using
them to prevent misinterpretation.3 We chose to analyse the
abbreviations used by orthopaedic surgeons, which equally apply to any other
group.4,6,9 The majority of the abbreviations in our study are not
correctly interpreted by the orthopaedic as well as non-orthopaedic specialties.
Medical abbreviations change their meanings across specialties2,4,6
and this poses a potential clinical risk in the health care provision.3,11
Our results show that abbreviations are poorly interpreted not only by the
members of the same specialty, but also by the members of the allied
specialties. Table 3 illustrates how abbreviations can change their meaning from
one specialty to another. The
general physicians and accident emergency physicians scored maximum in mis-interpretations
category, presumably because both these specialties work in abbreviation-rich
environment. The orthopaedic
surgeons were next in this group, possibly inherited from medical specialties;
more commonly used in patients known to have multiple medical co-morbidities.13
Downsizing the number of staff and Hospital at Night initiatives are the
current favourites in the UK.5 It is likely that the staff members,
who would previously have been dealing with their own specialty patients at
night, may now be looking after a broader spectrum of medical and surgical
patients, both in the acute and ward based settings.4 In such
situations, the only information available would be from the medical notes,
which are of varying quality, both in the content and legibility.3,6
In a study, 11.4% of the drug errors have been shown to be due to the use of
abbreviations.6 Our results have clearly shown that the abbreviations
may cause problems as a result of mis-interpretation.
With recent well-established changes in the medical practice towards the
multidisciplinary teams4 and from the results of this study, we would
suggest that incorrectly explained abbreviations only add to confusion and make
patients’ notes more difficult to interpret.3,14,15 Many strategies
have been devised in the past to eliminate unsafe abbreviations2-4,6,11,14,
including the suggestion that if information on the meaning of abbreviations is
made widely available, then this would suffice.1,4,7 With the
increased exposure of patients to health care professionals of varying
backgrounds, we have shown that the abbreviations may have different equally
correct meanings to different people and therefore simple generic explanations
would probably not be enough.2,15 No surprises as orthopaedic
surgeons scored maximum followed by physiotherapists perhaps because they work
closely with orthopaedic patients to improve their post-operative mobility.10
Although, blank answers are considered as benign (‘no harm done’), but
we believe that they are equally dangerous. These ‘don’t know’ situations
could lead to delayed actions in treating patients. However, it is quite
difficult to precisely calculate the delay in service provisions due to using
abbreviations.
Both incorrect answers and the mal-interpretations could result in
clinical errors.3,6,14,15
For clinical risk elimination, there is no role for the use of
abbreviations in the multidisciplinary world9,11 and that their
continued use will only lead to eventual clinical catastrophe.3,15 We
found that the abbreviations used by the junior doctors were later on wrongly
interpreted or left as blank in approximately 50% by the junior as well as
senior orthopaedic surgeons. We strongly believe that the use of abbreviations
is quite unsafe and unacceptable. We recommend that acronym obsession in the
junior doctors should be discouraged in order to reduce possible clinical error.
ACKNOWLEDGEMENTS
We wish to thank Mrs. Namita Kendall, consultant orthopaedic surgeon, St.
Richard’s Hospital, Chichester for her assistance in defining the correct
orthopaedic meanings of all abbreviations in the study.
We would also like to thank all the hospital staff members who kindly
agreed to participate in this study.
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