Inpatient osteopathic structural examinations: is "red tape" getting in the way of personalized patient care?

Previous studies suggest that the use of osteopathic structural examinations and osteopathic manipulative treatment (OMT) have declined dramatically in the hospital setting.

To determine frequency of use for osteopathic medicine's traditional manual diagnostic and treatment model and to evaluate the possible effects of required documentation.

A retrospective review of patients' medical records at nine Midwestern osteopathic hospitals.

Medical records for patients admitted to participating hospitals during February 2006 were examined for documented use of osteopathic structural examinations and OMT. Analysis evaluated the effects of using standardized forms to meet criteria established by the American Osteopathic Association (AOA). Subanalysis compared records from hospitals that used such forms with those that did not.

A total of 1047 patient medical records were evaluated, 418 (40%) of which met AOA criteria. Two-hundred twenty (35%) of the 629 non-AOA-compliant records showed that detailed osteopathic structural examinations were conducted. The use of standardized forms correlated with an increased use of OMT and an increased likelihood that examinations met AOA criteria (P<.001). However, standardized forms also led to fewer narrative descriptions of clinical findings.

Although many records documented the use of these examinations, this paperwork often failed to meet AOA criteria. To ensure high-quality, personalized patient care, expectations for hospital osteopathic structural examinations-including the importance of physician narratives in patient records-should be emphasized for osteopathic physicians-in-training.