title: On-Call Communication in Orthopaedic Trauma: "A Picture Is Worth a Thousand Words"--A Survey of OTA Members.
abstract: OBJECTIVE
  To quantify the effects of varying clinical communication styles (verbal and pictorial) on the ability of orthopaedic trauma surgeons in understanding an injury and formulate an initial management plan.
  
  
  METHODS
  A Research Electronic Data Capture survey was e-mailed to all OTA members. Respondents quantified (5-point Likert scale) how confident they felt understanding an injury and establishing an initial management plan based on the information provided for 5 common orthopaedic trauma scenarios. Three verbal descriptions were created for each scenario and categorized as limited, moderate, or detailed. The questions were repeated with the addition of a radiographic image and then repeated a third time including a clinical photograph. Statistical evaluation consisted of descriptive statistics and Kruskal-Wallis analyses using STATA (version 12.0).
  
  
  RESULTS
  Of the 221 respondents, there were a total of 95 who completed the entire survey. Nearly all were currently taking call (92/95 = 96.8%) and the majority were fellowship trained (79/95 = 83.2%). Most practice at a level I trauma center (58/95 = 61.1%) and work with orthopaedic residents (62/95 = 65.3%). There was a significant increase in confidence scores between a limited, moderate, and detailed description in all clinical scenarios for understanding the injury and establishing an initial management plan (P < 0.05). There was a significant difference in confidence scores between all 3 types of evidence presented (verbal, verbal + x-ray, verbal + x-ray + photograph) in both understanding and managing the injury for limited and moderate descriptions (P < 0.001). No differences were seen when adding pictorial information to the detailed verbal description. When comparing confidence scores between a detailed description without images and a limited description that includes radiographs and a photograph, no difference in confidence levels was seen in 7 of the 10 scenarios (P > 0.05).
  
  
  CONCLUSIONS
  The addition of images in the form of radiographs and/or clinical photographs greatly improves the confidence of orthopaedic trauma surgeons in understanding injuries and establishing initial management plans with limited verbal information (P < 0.001). The inclusion of x-rays and photographs raises the confidence for understanding and management with limited verbal information to the level of a detailed verbal description in most scenarios. Mobile technology allows for easy secure transfer of images that can make up for the lack of available information from limited verbal descriptions because of the knowledge base of communicating providers.
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Nashville, TN.
authors.forename: Cesar S
authors.initials: CS
authors.lastname: Molina
authors.forename: Alexandra K
authors.initials: AK
authors.lastname: Callan
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Burgos
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D003142:Communication; D019538:Health Care Surveys; D006801:Humans; D009985:Orthopedics; D010346:Patient Care Management; D010781:Photography; D011859:Radiography; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy