Use of medical abbreviations and acronyms: knowledge among medical students and postgraduates

Processing of Short-Form Content in Clinical Narratives: Systematic Scoping Review

BACKGROUND

Clinical narratives are essential components of electronic health records. The adoption of electronic health records has increased documentation time for hospital staff, leading to the use of abbreviations and acronyms more frequently. This brevity can potentially hinder comprehension for both professionals and patients.

OBJECTIVE

This review aims to provide an overview of the types of short forms found in clinical narratives, as well as the natural language processing (NLP) techniques used for their identification, expansion, and disambiguation.

METHODS

In the databases Web of Science, Embase, MEDLINE, EBMR (Evidence-Based Medicine Reviews), and ACL Anthology, publications that met the inclusion criteria were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for a systematic scoping review. Original, peer-reviewed publications focusing on short-form processing in human clinical narratives were included, covering the period from January 2018 to February 2023. Short-form types were extracted, and multidimensional research methodologies were assigned to each target objective (identification, expansion, and disambiguation). NLP study recommendations and study characteristics were systematically assigned occurrence rates for evaluation.

RESULTS

Out of a total of 6639 records, only 19 articles were included in the final analysis. Rule-based approaches were predominantly used for identifying short forms, while string similarity and vector representations were applied for expansion. Embeddings and deep learning approaches were used for disambiguation.

CONCLUSIONS

The scope and types of what constitutes a clinical short form were often not explicitly defined by the authors. This lack of definition poses challenges for reproducibility and for determining whether specific methodologies are suitable for different types of short forms. Analysis of a subset of NLP recommendations for assessing quality and reproducibility revealed only partial adherence to these recommendations. Single-character abbreviations were underrepresented in studies on clinical narrative processing, as were investigations in languages other than English. Future research should focus on these 2 areas, and each paper should include descriptions of the types of content analyzed.

Danger in discharge summaries: Abbreviations create confusion for both author and recipient

BACKGROUND

The transition from hospital inpatient care to medical care in the community is a high-risk period for adverse events. Inadequate communication, including low quality or unavailable discharge summaries, has been shown to impact patient care.

AIMS

Assess use of abbreviations in clinical handover documents from inpatient hospital teams to general practitioners (GPs), and the interpretation of these abbreviations by GPs and hospital-based junior doctors.

METHODS

Retrospective audit of 802 discharge summaries completed during a one-week period in 2017 by a Queensland regional health service. GPs and local junior doctors then attempted interpretation of twenty relevant abbreviations.

RESULTS

99% (794) discharge summaries included abbreviations. 1612 different abbreviations were used on 16 327 occasions. The median number of abbreviations per discharge summary was 17 (range 0-86). 254 GPs and 62 junior doctors responded to a survey which found that no abbreviation was interpreted the same by all respondents. GPs and junior doctors were unable to offer any interpretation in 17.9% and 15.2% of cases respectively. GPs offered a greater range of interpretations than junior doctors, with a median of 9 and 3 different interpretations per abbreviation respectively. 94% (239) of GPs felt that the use of abbreviations in discharge summaries had the potential to impact patient care. 152 (60%) GPs felt that time spent clarifying abbreviations in discharge summaries could be excessive.

CONCLUSIONS

Abbreviations are often used in discharge summaries, yet poorly understood. This has the potential to impact patient care in the transition period after hospitalisation This article is protected by copyright. All rights reserved.

A deep database of medical abbreviations and acronyms for natural language processing

The recognition, disambiguation, and expansion of medical abbreviations and acronyms is of upmost importance to prevent medically-dangerous misinterpretation in natural language processing. To support recognition, disambiguation, and expansion, we present the Medical Abbreviation and Acronym Meta-Inventory, a deep database of medical abbreviations. A systematic harmonization of eight source inventories across multiple healthcare specialties and settings identified 104,057 abbreviations with 170,426 corresponding senses. Automated cross-mapping of synonymous records using state-of-the-art machine learning reduced redundancy, which simplifies future application. Additional features include semi-automated quality control to remove errors. The Meta-Inventory demonstrated high completeness or coverage of abbreviations and senses in new clinical text, a substantial improvement over the next largest repository (6–14% increase in abbreviation coverage; 28–52% increase in sense coverage). To our knowledge, the Meta-Inventory is the most complete compilation of medical abbreviations and acronyms in American English to-date. The multiple sources and high coverage support application in varied specialties and settings. This allows for cross-institutional natural language processing, which previous inventories did not support. The Meta-Inventory is available at https://bit.ly/github-clinical-abbreviations.

Measurement(s)	Controlled Vocabulary • Linguistic Form
Technology Type(s)	digital curation • data combination
Sample Characteristic - Location	United States of America

Machine-accessible metadata file describing the reported data: 10.6084/m9.figshare.14068949

Uncovering Hidden Curricula: Use of Dark Humor in Anatomy Labs and its Implications for Basic Sciences Education

Humor is subjective within most settings, but within the anatomy laboratory, it is likely to be significantly more contentious. While humor may be considered a component of the hidden curriculum of medical education, it has yet to be studied specifically from a basic sciences perspective. This study sought to understand if, when, how, and why humor may be used in anatomy labs and the implications this may have in basic sciences education. A survey consisting of demographic and qualitative items was designed to sample widely from academics, students, and health professionals with anatomy laboratory experience. A total of 185 respondents, representing 9 countries participated following purposive sampling and snowball recruitment. Findings of significance were 72% of respondents who had experienced dark humor within the anatomy lab. Themes identified from free-text pertained to the use of internal and external barometers to ascertain the appropriateness of humorous remarks and the use of humor as a mechanism for diffusing stress. Polarity in responses concerning the acceptability of dark humor and rude mnemonics was also observed. This study highlighted that while dark humor may be a perceived tension release, many individuals make use of very specific internalized gauges to determine when and what humor may be appropriate. The data emphasized the need for not only future humanistic-focused anatomy but also basic sciences, education research, to better understand and have ideal educational experiences for all. Finally, this study provided further evidence of the impact of the hidden curriculum associated with the use of humor within educational and professional settings.

Analysis of abbreviations used by residents in admission notes and discharge summaries

BACKGROUND

There are abbreviations that are used daily such as BP for blood pressure and ECG for electrocardiogram, but many of the abbreviations found in medical documents are unclear.

AIM

The purpose of this study was to assess the frequency, type and comprehension of abbreviations in admission notes and discharge letters composed by orthopedic surgery and medical residents.

METHODS

Abbreviations were extracted from discharge letters and admission notes composed by residents from orthopedic surgery and medical wards. The frequency of use of the abbreviations was determined. Additionally, the fifty commonest abbreviations from each specialty were graded by three medical and three orthopedic surgery senior physicians as 1. understandable or 2. Ambiguous or unknown.

RESULTS

The number of abbreviations found in the documents composed by medical and orthopedic surgery residents was 1525 with 80 different abbreviations and 493 with 51 different abbreviations respectively (9.3% and 4.9% of the total word number respectively). Analysis revealed that 14% of the abbreviations from medical ward documents were graded as ambiguous or unknown by medical senior physicians compared with 25% by senior orthopedic surgeons. When abbreviations from orthopedic surgery documents were presented to both groups, senior orthopedic surgeons graded 8% as ambiguous or unknown compared with 21% by the medical senior physicians.

CONCLUSION

In order to prevent impairment of patient care, only standard abbreviations should be used in medical documents. Measures should be taken to decrease the use of non standard abbreviations such as the incorporation of authorized abbreviations to the electronic medical record.

Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician’s efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor–patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics

Impact of a scribe program on patient throughput, physician productivity, and patient satisfaction in a community-based emergency department

Previous literature on the impact of scribe programs varies and has mostly been reported from academic institutions or other clinics. We report the implementation of the scribe program in the emergency room of a community hospital and its impact on patient throughput, physician productivity, and patient satisfaction. We performed a quasi-experimental, before-and-after study measuring patient throughput metrics, physician productivity, and patient satisfaction. The intervention measuring the scribe implementation was divided into pre- and post-implementation periods. Patient throughput metrics were (1) door-to-room time, (2) room-to-doc time, (3) door-to-doc time, (4) doc-to-disposition time, and (5) length of stay for discharged/admitted patients. Our secondary outcome was physician productivity, which was calculated by measuring total patients seen per hour and work relative value units per hour. Additionally, we calculated the time-motion analysis in minutes to measure the emergency department physician's efficiency by recording the following: (1) chart preparation, (2) chart review, (3) doctor-patient interaction, (4) physical examination, and (5) post-visit documentation. Finally, we measured patient satisfaction as provided by Press Ganey surveys. Data analysis was conducted in 12,721 patient encounters in the pre-scribe cohort, and 13,598 patient encounters in the post-scribe cohort. All the patient throughput metrics were statistically significant (p < 0.0001). The patients per hour increased from 2.3 ± 0.3 pre-scribe to 3.2 ± 0.6 post-scribe cohorts (p < 0.001). Total work relative value units per hour increased from 241(3.1 ± 1.5 per hour) pre-scribe cohort to 336 (5.2 ± 1.4 per hour) post-scribe cohort (p < 0.001). The pre-scribe patient satisfaction was high and remained high in the post-scribe cohort. There was a significant increase in the clinician providing satisfactory feedback from the pre-scribe (3.9 ± 0.3) to the post-scribe (4.7 ± 0.1) cohorts (p < 0.01). We describe a prospective trial of medical scribe use in the emergency department setting to improve patient throughput, physician productivity, and patient satisfaction. We illustrate that scribe use in community emergency department is feasible and results in improvement in all three metrics.