It’s common practice for patients being discharged from hospital to be given a letter for their own GP. This is supposed to ensure that the doctor has a full understanding of the treatment or procedure the patient has had and can provide a continuation of care. However, GPs are failing to understand the common abbreviations used in hospital discharge letters and this could contribute to the illness or even death of their patients.
The Nepean Hospital in Penrith NSW analysed 200 discharge letters over two weeks in 2012, with researchers identifying 15 of the most commonly used abbreviations, as well as five important terms that were used less often. A survey of 132 GPs in the Nepean Blue Mountains Health district was then undertaken, with six of the abbreviations misinterpreted by over 25 per cent of the GPs.
The study, which was published in the Medical Journal of Australia yesterday, is cause for concern, with the authors of the study writing:
“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.
“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. Our findings highlight an area that may contribute to patient morbidity or mortality because of miscommunication between healthcare practitioners.”
The GPs were not asked to provide details of their careers, for example how long they had been practicing and as the doctors came from a specific geographic area, the results may not apply elsewhere. However, chair of the e-health standing committee at the Royal Australian College of General Practitioners, Dr Nathan Pinskier, said the results were not surprising.
“Consistent with any other documentation industry, people make up their own shortcuts that work for them, but it doesn’t mean it’s easily translatable,” he said. “I’m the medical director of an after-hours service and I review the medical notes of overnight doctors, which are sent back to general practitioners, and I’m consistently seeing abbreviation because it’s quicker, and it becomes part of the terminology.”
Dr Pinskier said that GPs also had to try to understand abbreviations commonly used by a wide range of specialists and that there was a lack of standardisation in terms used.
While the authors of the study suggest that it would be impractical to ban the use of abbreviations in discharge letters, they did suggest a list of approved abbreviations for use on medical forms and auto-correct software which would complete the abbreviations when electronically entered.
Read more at The Guardian.
I can understand the ease and speed of using abbreviations, but when patients are suffering as a result of GPs not getting them right, then it’s time to stop the practice.
We can all get abbreviations or common phrases wrong from time to time, and the beauty of this is that most of us simply get to laugh it off. But when a GP makes a medical decision for a patient based on misinterpretation of information, there’s little to laugh about. Hospitals are busy places and the push to discharge patients only intensifies what can sometimes be a testing situation. Discharge letters are the last piece in the puzzle for a patient’s treatment, but that doesn’t mean they should simply be fired off without any care or consideration.
What is possibly more concerning is the abbreviations that the GPs misinterpreted. Even without medical training, you can see that some of them should be considered fairly standard:
SNT – soft non-tender
TTE – transthoracic echocardiogram
EST – exercise stress test
NKDA – no known drug allergies
CTPA – computed tomography pulmonary angiography
ORIF – open reduction and internal fixation
Abbreviations used in the field of medicine should be standardised, not something made up on the spot. Maybe if GPs started to call the doctors in question at the hospital every time they were unsure what an abbreviation meant, then the practice would cease and hospital doctors would be a little more considerate in future.
While abbreviations or accepted terms have their place in everyday language, medicine needs to hold itself to different standards, standards that are beyond reproach. If that means taking a little more time to spell terms out in full for the good of the patient, then so be it.
Of course, it’s noted that this study is reflective of a small geographic area, but it is more than likely that the findings would be similar elsewhere. And given that GPs and doctors can practice across the country, then the need for standardisation of terms is very clear.
Do you think the study is too small to be reflective of the whole of Australia? Should more care be given by doctors discharging hospital patients? Should GPs clarify with doctors if they are unsure what is written in a discharge letter?