Comparing diagrammatic recording versus traditional written account of tympanomastoid procedures: completion of a second audit cycle of 25 cases: Our experience Kum, F.* & Kanegaonkar, R.* † *Department of Otorhinolaryngology, Medway Maritime Hospital, Gillingham, † Canterbury and Christ Church University, Rochester, Kent, UK Accepted for publication 10 November 2014 Dear Editor, The accurate recording of operative findings and procedures is important for effective patient management. These notes are relied upon for monitoring patients in the immediate post-operative period, at follow-up, during revision proce- dures and also enable surgeons to audit their outcomes. The middle ear and mastoid are complex composite anatomical structures that are difficult to represent graphically. Traditional written accounts may be inaccurate and misleading, hence can be open to misinterpretation and misunderstanding. A standardised template has been designed and compared with traditional written accounts for recording tympano- mastoid procedures. An audit of version 1.0 of the template was conducted in 2011, and a subsequent version 2.0 has now been introduced. 1,2 The key modifications from version 1.0 to version 2.0 (Fig. 1) were conversion of the proforma to a double- sided operative note and the addition of spaces to record the name of operation performed and date of procedure. These were noted as key aspects lacking in version 1.0. Furthermore, subheadings prompting documentation of ‘Status of ossicular chain at end of procedure’, ‘Packs and closure’, ‘Post-op instructions’, ‘Follow-up instructions’, and ‘Post-operative hearing and facial nerve status’ were also included. Methods This was a retrospective audit of 25 cases in which the new template (version 2.0) was used to record tympa- nomastoid procedures (including myringoplasty, tympa- noplasty and mastoid exploration) between August 2012 and November 2013. The International Otology Database was used as the gold standard to construct a list of 35 items which were deemed essential for accurate docu- mentation. 3 This list was subdivided into Details, Find- ings, Procedure and Post-operative details. Non-applicable items of information were excluded from assessment of that operative account, for example, if an ossiculoplasty was not performed, this item was excluded from the total. Ethical approval was not required as this audit did not influence patient management. The audit was registered with the Trust Audit Department. This second cycle re-audit measures results against the previous audit, which compared traditional handwritten accounts and the use of version 1.0 of the standardised diagrammatic template. 2 A two-tailed t-test was used to statistically compare all three data sets. Results Use of template version 2.0 resulted in the recording of 78% of essential items, compared to 71% in version 1.0 and just 50% when using the traditional written account. Thus demonstrating a significant improvement in recording between version 2.0 and traditional written accounts (P = 0.002). However, when comparing the minor improvements made between version 2.0 and version 1.0, a further improvement was present, but not deemed statistically significant (P = 0.3). Table 1 below shows the percentage of each item which was recorded using each of the operative recording methods. Discussion Key findings Completion of this second cycle audit confirmed that the introduction of a standardised method for recording complex otological procedures encourages and improves documentation of operative notes. The introduction of changes between version 2.0 and version 1.0 of the operative template further improved standard Correspondence: F. Kum, Department of Otorhinolaryngology, Medway Maritime Hospital, Gillingham. Tel.: +44 (0)7709229998; e-mail: francesca.kum@doctors.org.uk © 2014 John Wiley & Sons Ltd  Clinical Otolaryngology 40, 266–290 266 CORRESPONDENCE:OUREXPERIENCE