While regarded as an essential means of communication between hospitals and GPs to facilitate optimal care of patients returning to the community, electronic hospital discharge letters, or eDLs, are insufficiently understood by doctors, and this is putting patient wellbeing at risk.
This is the key result of a major survey of GPs in Sydney’s Nepean Blue Mountains area, and the findings are likely to apply elsewhere.
The 2012 survey, details of which were published recently in the Medical Journal of Australia was based on an audit of 321 identified abbreviations used at Nepean Hospital.
From these, the 15 most commonly used, as well as five clinically important abbreviations, were selected.
Around 55 per cent of the 240 GPs contacted by mail chose to respond. The results included the finding that no single abbreviation was correctly interpreted by all the participating GPs, while six abbreviations were misinterpreted by more than a quarter of GPs.
These were SNT (soft non-tender, interpreted incorrectly by 47 per cent), TTE (transthoracic echocardiogram), EST (exercise stress test), NKDA (no known drug allergies), CTPA (computed tomography pulmonary angiogram), and ORIF (open reduction and internal fixation).
The researchers concluded that abbreviations used in eDLs are not well understood by GPs receiving them and “this has the potential to adversely affect patient care in the transition from hospital to community care…
“Worryingly, more than half of the abbreviations we found related to investigations, management or services that we considered to be the most clinically significant categories.
“Misinterpretation of abbreviations by GPs can adversely affect patient care through duplication of investigations, failing to institute treatment based on investigation results or failing to follow up with recommended management.”
They said potential solutions included banning the use of abbreviations or using only a limited number of hospital-approved abbreviations and providing GPs with an approved abbreviation list.
“Another option would be use of computer software to auto-complete mutually exclusive abbreviations (ie, allowing only one possible meaning for each),” they added.
They explained that abbreviations used in medical communications are either acronyms or initialisms.
“Acronyms use the initial letters of words and are pronounced as words (eg, ASCII, NASA); initialisms use initial letters pronounced separately (eg, BBC). Abbreviations are commonly used in medical specialties, but may not be understood by the broader profession. Doctors are under pressure to complete discharge letters in a timely fashion, and abbreviations may be used to facilitate this process.”
They cited reports that abbreviation use is increasing and identified this as a concern. A recent audit at Royal Melbourne Hospital reported that 20.1 per cent of all words in discharge letters were abbreviations.
One study audited abbreviation use in inpatient medical records and surveyed members of an inpatient multidisciplinary team for their understanding of abbreviations.
The mean correct response rate was 43 per cent, with Postgraduate Year 1 doctors posting the best scores (57 per cent) and dietitians posting the worst (20 per cent).
“However, we identified no published studies determining whether the abbreviations used in hospital discharge letters are understood by GPs, who are usually the recipients of discharge letters.”
General practitioner understanding of abbreviations used in hospital discharge letters Med J Aust 2015; 203 (3): 147. Mark Chemali, Emily J Hibbert, Adrian Sheen, Mark Chemali, Emily J Hibbert and Adrian Sheen