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Many GPs misunderstand discharge letter shorthand

Survey reveals a more than a quarter of GPs misinterpret six common abbreviations

Mark Gould

Tuesday, 04 August 2015

More than a quarter of GPs regularly misinterpret common abbreviations used in hospital discharge letters, a new study* has found.

Writing in the Medical Journal of Australia researchers analysed 200 hospital discharge letters issued over two weeks in 2012, identifying the 15 most common abbreviations, plus five lesser-used, but important ones.

They then surveyed 132 general practitioners within the Nepean Blue Mountains Health district of New South Wales, finding six of the abbreviations were misinterpreted by more than a quarter of them.

There were 321 abbreviations in the letters examined; 11.3% of these were used in more than 10 separate letters. The remainder were less common, with 78.8% being used fewer than four times.

The six most common abbreviations were SNT (soft non-tender), TTE (transthoracic echocardiogram), EST (exercise stress test), NKDA (no known drug allergies), CTPA (computed tomography pulmonary angiography), and ORIF (open reduction and internal fixation). They were interpreted incorrectly by 47.0% (62), 33.3% (44), 33.3% (44) 32.6% (43), 31.1% (41) and 28.0% (37) of GPs, respectively.

“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,” the authors wrote.

“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 researchers said given they had not asked the general practitioners demographic information, including the length of their careers, which may have impacted on their level of understanding. The abbreviations and doctors studied came from a particular geographic area, and the results may not apply everywhere.

However, “it would be imprudent to ignore the magnitude of these findings and not act to minimise the potential problems,” they concluded.

The Royal Australian College of General Practitioners, said it was not surprised by the results as technology is developing so rapidly in the medical field that new medical terms and abbreviations for them are growing. It was concerned at a lack of standardisation of some of the terms, and even commonly accepted and understood abbreviations could be confusing.

The authors of the study suggest a number of solutions, including banning the use of abbreviations on discharge forms, however, they acknowledge this would be impractical.

* Mark Chemali, et al. General practitioner understanding of abbreviations used in hospital discharge letters. Med J Aust 2015; 203 (3): 147. DOI: 10.5694/mja15.00224

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