Gross no more: The quest for clean reports

In seeking internal uniformity of reporting language, recommendations from program administration and repeated reminders to faculty and trainees can help eliminate unclear terminology, though a small percentage of providers will be slow to change, according to an article published in the April issue of the Journal of the American College of Radiology.

The conclusion is based on efforts to erase the terms gross and grossly from radiologists’ reporting vocabulary at Beth Israel Medical Center in New York City. These terms are not part of the RadLex universal lexicon, and can have multiple meanings both to imaging professionals and to lay readers, wrote Daniel K. Powell, MD, and colleagues.

“Words can be deleterious to a report if they are unclear, misleading, or carry negative connotations,” wrote the authors. “Many inappropriate or inaccurate terms have endured simply by tradition.”

The chairman and program director emailed radiology department faculty and trainees (residents and fellows) to request they eliminate the terms gross and grossly from reports. Alternatives, such as discernible or obvious, were suggested, and reminders were sent in subsequent emails and mentioned at departmental quality improvement meetings for two months. A total of 51 faculty members and 30 trainees had their reports evaluated, with changes assessed at three and nine months after recommendations were made.

After three months, use of the terms in faculty members’ reports fell from 5.9 percent of reports to 2 percent, and in trainees’ reports use fell from 6 percent to 2.7 percent, according to Powell and colleagues. Incidence continued to decrease through the full nine months, but the decline from three to nine months was not statistically significant compared with the initial drop.

Median rate of use was less than 2 percent after nine months, and while no faculty members completely ceased using gross or grossly, one in five trainees were no longer using the terms in reports.

Three residents and six faculty members, representing 10 percent and 11.8 percent, respectively, of their subgroups, continued to use the terms at a rate greater than one standard deviation over the post-intervention mean.

In surveys, more than 90 percent of both faculty and trainees said they valued standardized reporting, but just over 70 percent from each group said they wanted more language guidelines implemented, wrote the authors. “In other words, 23.5 percent of 34 surveyed faculty members and 20 percent of 10 residents who valued standardized language did not want further guidelines from our institution.”

Powell and colleagues noted that the continued, albeit declined, use of the terms gross and grossly suggested the terms are considered somewhat useful to indicate uncertainty or avoid mentioning unnecessary detail. “The lack of precision or any material information provided by these terms may be a reminder of the sometimes ‘fuzzy’ nature of our field, which cannot always ‘rule out’ those things that are not seen.”