Synoptic Operative Reports More Complete Than Narrative Reports

By Scott Baltic

June 24, 2019

NEW YORK (Reuters Health) - For recording the results of surgical procedures, synoptic reporting - that is, template-based, procedure-specific reporting - is significantly more complete than traditional narrative reporting, according to a new systematic review.

The study also found hints that synoptic reporting might take less time to complete, and that such reports were more reliable, of higher quality overall, and cost somewhat less than narrative reporting, which typically is dictated after an operation is performed.

"This implies improved quality documentation of surgical details and communication of operative elements amongst care providers," Dr. Ashley Vergis of the Max Rady College of Medicine, University of Manitoba, in Winnipeg, Canada, and colleagues write. "This may have the potential to enhance the quality of patient care."

The research, online May 14 in the The American Journal of Surgery, is the first systematic review and meta-analysis to assess the value of synoptic operative reporting versus traditional narrative reporting, the team notes.

The review encompassed 16 studies that compared a synoptic operative report to a narrative operative report. The studies included a total of 1,343 synoptic and 1,417 narrative reports and were primarily from North America, though two were from the U.K.

A synoptic report was defined as "any reporting platform employing a standardized format for the procedure including computerized and noncomputerized reporting templates." A narrative report was defined as one that was "dictated or written ad lib without a standardized format."

The primary outcome was completeness, measured as a percentage of predetermined items considered critical to documentation of the procedure in question. Dr. Vergis explained in an email to Reuters Health that these lists of critical items were developed through a national Canadian Delphi survey of community and academic surgeons, gastroenterologists, acute-care surgeons, and radiologists.

The meta-analysis found synoptic reporting to be significantly more complete than narrative reporting.

Time to complete the operative report was non-significantly shorter for synoptic reporting, and efficiency, quality, reliability and cost-effectiveness measures all showed trends favoring synoptic reporting.

The authors pointed out that synoptic reporting eases data collection and interpretation and helps to consolidate relevant patient data, all of which contribute to quality care.

On the question of how well synoptic reporting meshes with electronic health records (EHRs), the short answer is that it depends. At his institution, Dr. Vergis said, the EHR and synoptic report are independent, but the synoptic document can be imported.

"Unfortunately, you lose the data-capture ability from the report in the EHR and would have to go back to the specific synoptic platform to extract data," he said.

"A major criticism of synoptics is the loss of the operation's 'flavour' and nuance," he noted, adding that this is platform dependent and likely to be improved in the future.

Dr. Samuel Alan Stewart, assistant professor of medical informatics at the Faculty of Medicine, Dalhousie University, in Halifax, Canada, told Reuters Health by email, "Synoptic reporting generally fits very well within current EHRs."

"The good EHRs are generally customizable to the clinicians' needs, so they can choose how structured or unstructured their reporting is," said Dr. Stewart, who was not involved in the review. "Synoptic reports are best when they have a narrative component, to allow clinicians to record all information that they think is relevant, and not just the information that the report designers think is relevant."

He noted, "My impression is that most clinicians would prefer narrative vs. synoptic reporting," in part because of how they are trained and in part because "they don't like to be told how/what to report." There's also a sense among clinicians that synoptic reporting is slower than narrative reporting, he said.

The study received no specific funding, and the authors declared no competing interests.


Am J Surg 2019.