“No BLT”: The Rise and Risk of Acronyms in the Medical Record

BLT, SSCP, WHOL—the use of acronyms has expanded, comprising large portions of most clinicians’ notes. We present examples of acronyms found in medical records at our institutions and collected as part of an initiative among three ethics committees to demonstrate not only their widespread use, but also the breadth of the types of acronyms used in the medical record. Acronyms have traditionally been used in medical charting to increase efficiency. However, acronyms can impede patient care because they are prone to misinterpretations and misunderstandings between medical professionals. Such misunderstandings have led to incorrect pharmaceutical dosage administration and misdiagnoses. With patients gaining access to their medical records under the Cures Act in 2020, clinicians must also consider the readability of their notes not only for colleagues, but also patients. We provide four different solutions to help mitigate the use of acronyms in medical records while balancing clinician interests in efficiency: creating and implementing “do not use” lists for commonly misunderstood acronyms, leading educational sessions and audits to ensure clinical care team members adhere to “do not use” lists and “approved acronyms” lists, implementing an Electronic Health Record with functionality to create “user dictionaries” in which typed acronyms automatically become full phrases, and seeking feedback from care team members and patients on whether notes have become more “readable” after implementation of initial strategies. Though the use of acronyms may continue to be a feature of medical communication, we hope to encourage the reduction and then judicious use of acronyms.