V. Vacharathit1, V. Vacharathit2, C. Tu3, G. Morris-Stiff1 1Cleveland Clinic,General Surgery,Cleveland, OH, USA 2Johns Hopkins,Molecular Microbiology And Immunology,Baltimore, MD, USA 3Cleveland Clinic,Biostatistics,Cleveland, OH, USA
Introduction:
Few documents are as important as operative reports (ORs) for physicians taking care of postsurgical patients, yet these documents are variable in quality, detail, and accuracy. This may result in decreased ability to plan medical and surgical care, thereby decreasing its quality. No studies to date have rigorously explored the effectiveness of using a customizable illustrated operative report (IOR) to bridge the communication gap that exists between surgeons and other providers. We propose that usage of IORs to supplement conventional ORs will enhance multidisciplinary communication and improve understanding of patient postoperative changes.
Methods:
To quantify the effectiveness of IORs vis a vis coventional dictated ORs, we conducted a randomized controlled trial with respondents (surgical residents wound care/ostomy nurses, nutritionists, and surgical nurses; n=174) blindly randomized to either the control (only dictated ORs; n=72) or experimental group (received the same ORs plus illustrations of the final anatomy; n=102). Respondents were asked interpretative questions based on three patients: 1) a routine Roux-en-y gastric bypass (denoted as “simple”) 2) a Whipple operation with prior Billroth II anatomy (“complex”) and 3) a trauma requiring sequential re-laparotomies and bowel resections (“sequential”). Accuracy and time needed to read and answer questions were quantified. Results were analyzed with the Chi-squared, Fisher’s exact and Wilcoxon rank sum tests. Two tailed comparisons were performed at a significance level of 0.05.
Results:
The control group was consistently less accurate in answering analytical questions even when adjusted for differing difficulty levels between operation types (allowed 1 incorrect response per section): 53% vs 71% answered accurately in simple operations (p=0.024), 24% vs 52% in complex operations (p<0.001), and 42% vs 60% in sequential operations (p=0.034). This trend was mirrored in the general surgery resident subpopulation but did not reach statistical significance (89% vs 97%; 51% vs 65%; and 67% vs 86% in simple, complex, and sequential operations, respectively). Time needed to read and interpret reports was also decreased with IORs: mean 377s vs 290s in simple (p=0.021); 354s vs 360s in complex (p=0.89), and 442s vs 327s in sequential operations (p=0.017). IORs increased confidence and overcame perceived hurdles in comprehending conventional ORs (jargon, too detailed, style of ORs) with 94% respondents recommending its usage overall and in resident (96%) and patient (97%) education.
Conclusion:
The use of customizable illustrations increased interpretative accuracy of ORs and decreased time needed for their interpretation. While effects were more pronounced for non-surgeons, subjective benefits were felt across the board. Creation and routine usage of IORs could improve communication between healthcare practitioners and serve as a teaching and learning tool for surgical trainees.