A cross-sectional retrospective study comparing handwritten operation notes with electronic operation notes

INTRODUCTION

Electronically completed medical notes have been shown to be superior in legibility and completeness to handwritten ones. Despite this, surgeons continue to use handwritten operation notes. This paper aims to compare the quality of handwritten versus electronic operation notes.

METHODS

This is a retrospective cross-sectional single-centre study done at Darent Valley Hospital, a district general hospital at Dartford, UK. We looked at 405 operation notes of patients who had general surgery procedures between 1 January 2020 to 31 January 2021 checking for legibility and completeness of operation note criteria as given by the Royal College of Surgeons of England's Good Surgical Practice. Data were collated using an app that populates comparison criteria in an Excel sheet and were analysed using SPSS (Statistical Package for the Social Sciences). The results are presented in bar graphs and frequency table.

RESULTS

In 17 out of the 18 criteria in RCS England's Good Surgical Practice, electronic notes were better completed than handwritten ones (p<0.001). Signature as a criterion had comparable level of completeness in both handwritten and electronic notes, 95% versus 91% respectively. There was 8.3% illegibility in the handwritten note and none in the electronic ones.

CONCLUSIONS

Electronic notes are far better completed than handwritten notes in 17 out of the 18 criteria of a good operation note by RCS England. The difference between both forms of notes is far too much; we propose a complete shift in practice from handwritten to electronic format.

108 Improving the Quality of General Surgery Operation Notes

Introduction

As outlined in Good Surgical Practice by the Royal College of Surgeons (RCS), accurate, comprehensive, legible, contemporaneous, and preferably electronic operation notes are fundamental in maintaining effective communication, patient safety and overall quality of patient care.

Aim

To improve the quality of general surgery operation notes by increasing the documentation of the 18 key criteria recommended by the RCS, and increasing the quantity of operation notes completed electronically.

Method

Operation notes were reviewed for the documentation of the 18 key criteria. Initial audit aimed to gather baseline after which five actions aimed to increase the use of electronic notes were undertaken (including implementation of electronic operation notes proforma, presentation in the surgical morbidity and mortality meeting). Thereafter, a re-audit reviewed operation notes for the documentation of the same 18 criteria. As handwritten notes continued to be used in the re-audit, we took the initiative to also compare documentation between handwritten and electronic notes. For this purpose, 158 operation notes were randomly selected (80 handwritten, 78 electronic) and documentation of key criteria were compared.

Results

Use of electronic notes increased by 59%. There was an overall increase in documentation between the initial audit and the re-audit. On comparison of handwritten vs electronic notes, the total relative risk of not completing key criteria 0.461 (95%CI 0.417-0.509), p&lt;0.0001.

Conclusions

The audit was successful in increasing the documentation of key criteria. When comparing handwritten vs electronic notes, the data show that electronic notes significantly reduce the risk of not completing key criteria.

Narrow band UVB (311 nm), psoralen UVB (311 nm) and PUVA therapy in the treatment of early-stage mycosis fungoides: a right-left comparative study

BACKGROUND

Psoralen ultraviolet A (PUVA) is a widely used first-line therapy for treatment of early cutaneous T-cell lymphoma. Narrow band UVB (UVB-NB) (311 nm) has been recently introduced as another effective line of treatment. It is postulated that the efficacy of UVB-NB could be enhanced by addition of psoralen.

AIM

The aim of the present work was to compare the clinical and histopathologic efficacy of PUVA and UVB-NB in the treatment of early-stage MF (stages IA, IB and IIA), and to evaluate whether psoralen adds to the efficacy of UVB-NB or not.

PATIENTS AND METHODS

Twenty patients (stage IA, IB or IIA) were divided into two equal groups: group I received UVB-NB on the right body half vs. PUVA on the left side of the body for 48 sessions, and group II received PUVB-NB on the right side of the body vs. PUVA on the left side for 36 sessions. The sessions were administered three times weekly.

RESULTS

In group I, almost equal results were obtained on both sides, i.e., UVB-NB and PUVA were equally effective in the treatment of early stages of MF, both clinically and histopathologically. In group II, PUVB-NB was found to be as effective as conventional PUVA in the treatment of early-stage mycosis fungoides, also on both clinical and histopathological grounds.

CONCLUSION

UVB-NB phototherapy should be included among the initial therapeutic options of mycosis fungoides in view of its efficacy, convenience, and likelihood of fewer long-term adverse effects. Addition of psoralen does not seem to enhance its therapeutic efficacy.

Different low doses of broad-band UVA in the treatment of morphea and systemic sclerosis

BACKGROUND

Numerous treatment modalities, some with potentially hazardous side effects, are currently used for morphea (M) and systemic sclerosis (SS) with limited success. Low-dose ultraviolet A (UVA) phototherapy (20 J/cm(2)) was found to be highly effective for sclerotic patches, even in patients with advanced and rapidly evolving lesions.

OBJECTIVE

To determine the effectiveness of different low doses of UVA in treating patients with M and SS.

METHODS

Sixty-three patients complaining of M and 15 patients complaining of SS received 20 sessions of UVA (320-400 nm) each. Patients were divided randomly into three groups that received 5, 10 and 20 J/cm(2), with cumulative UVA doses of 100, 200, and 400 J/cm(2), respectively. The efficacy of therapy was judged clinically (by sequential inspection and palpation) and histopathologically by morphometry in M cases.

RESULTS

Obvious clinical improvement, with no comparable differences between various low UVA doses, was noted in patients with M and SS, accompanied by histopathological changes towards normalization of collagen.

CONCLUSIONS

After 20 sessions, it appears that lower doses of UVA (5, 10 J/cm(2)) are as beneficial as the relatively higher dose (20 J/cm(2)) in the treatment of M and SS.