Background: Electronic medical record notes have been determined to be lacking in quality, accessibility and content. Structured note templates could provide a way to improve these aspects, particularly with regard to data availability for research and quality improvement. Objective: To determine whether the implementation of a standardised template for hernia documentation can improve data completeness and timeliness. Method: Retrospective review of clinic notes of 30 patients, 15 prior to implementation of a standardised note template and 15 after implementation of the template. The number of the 21 Americas Hernia Society Quality Collaborative (AHSQC) variables which were present in the notes was recorded, as was the time that the consultation ended and the time that the note was submitted. Results: Mean number of variables collected prior to implementation of the template was 5.9 ± 1.6 vs. 20 ± 0.4 after implementation ( p < 0.001). In the pre-implementation group, 20% of the notes were completed after the day of the visit, while all of the notes in the post-implementation group were completed on the same day as the visit ( p = 0.367). Conclusion: Implementation of a structured note template resulted in significantly improved capture of specific database variables within clinical notes. Structured note templates are an effective tool to improve data capture from the clinical setting for research and quality improvement.

Systematic cavity shave margins (CSM) can decrease rate of positive margins and re‐excision beyond that of selective CSM. The objective of this study was to determine whether systematic CSM decreased re‐excision rate in a population with a low baseline re‐excision rate. We conducted a retrospective chart review of patients who underwent breast‐conserving surgery (BCS) from November 2013 to November 2017. Primary end points were re‐excision rate and margin status. Secondary end points were total volume of tissue excised, operative time, and concordance of core needle biopsy (CNB) pathology with final surgical pathology. The re‐excision rates were 14.29% in the no shave margin group; 15.38% in the selective CSM; and 14.59% in the systematic CSM (P = .985). Odds of re‐excision with ductal carcinoma in situ (DCIS) was 5.04 times greater than with invasive cancer (INV) and 1.94 times higher than with INV and DCIS. There was no significant difference in positive margins between groups (P = .362). Mean specimen volume was lowest in the systematic CSM group (64.6 cm3), compared to no CSM and selective CSM (94.6 cm3 and 91.8 cm3, respectively). With inclusion of shave margin volumes, total volume removed was not significantly different between no shave margin group (94.6 cm3) and systematic CSM (89.7 cm3) (P = .949). For patients with invasive ductal carcinoma (IDC) alone on their initial biopsy pathology, 69% were discovered to also have DCIS upon final pathology. Re‐excision rate and specimen volume between all groups were not statistically different. There was a higher re‐excision rate when DCIS was present, especially when not identified on CNB. As systematic CSM is most impactful when DCIS is involved, it is important to establish its presence for proper surgical planning.

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