A Picture Is Worth A Thousand Words: Embedded Images Within Operative Reports Improve Understanding and Quality

Emily Huang, MD, Jonathan Carter, MD. University of California San Francisco.

 INTRODUCTION: Modern electronic health records allow surgeons to easily embed photographs or diagrams into the formal operative report. We hypothesized that such embedded images improve reader understanding and capture procedural information not easily conveyable in words.

METHODS: A cohort of surgeons and non-surgeons were asked to read a text-only operative report and then answer Likert-style questions on their understanding of procedural steps, anatomy, findings, and difficulty of the operation. They then re-read the same operative report, this time with embedded photographs depicting key findings and points along the way. Respondents were surveyed again. Two operative reports were chosen for survey because of their conceptual complexity: 1) laparoscopic esophageal diverticulectomy with esophagomyotomy and 180 degree fundoplication in the setting of a large paraesophageal hernia, and 2) open radical resection of metastatic melanoma to the small intestines.

RESULTS: Twenty-five respondents completed the survey. Embedded images significantly improved reader understanding of all categories: procedural steps, anatomy, tissue quality, specimens, and difficulty (Figure 1, p< 0.03). Improvements were strongest in understanding of unusual anatomy, tissue quality, and specimen quality. Both surgeons and non-surgeons reported improved understanding when pictures were added to the operative report. 79% of respondents agreed that pictures improved patient care, and 96% agreed that pictures improved the overall quality of documentation.

CONCLUSIONS: Adding visual information to operative reports improved documentation quality and provider understanding for both surgeons and non-surgeons. Surgeons should routinely provide images within their reports of patient procedures, just as gastroenterologists, pathologists, and radiologists already do today.

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