Reconsidering ambiguous language in infectious disease consult recommendations

Infectious diseases (ID) consultations are associated with improved patient outcomes. We aimed to determine whether ambiguous language affects adherence to recommendations.

We conducted a retrospective study of consecutive ID consultations across four campuses of a 2,500 bed hospital network in 2024. Ambiguous language use was quantified and described. The relationship between ambiguous language and adherence to recommendations was assessed using univariable and multivariable mixed effects logistic regression, with consult episode as a random effect. Other predictors of ambiguous language and adherence were assessed and adjusted for, including referring unit, consulting team demographics, recommendation type and number of recommendations.

1087 recommendations were made across 250 consecutive consultations. Of these, 106/1087 (9.8%) used ambiguous language, most commonly the expression "consider". Adherence was assessable in 977/1087 recommendations. Adherence to assessable non-ambiguous recommendations was 87.2% (725/903 [80.3%] completely followed, 62/903 [6.9%] partially followed), while adherence to ambiguous recommendations was 59.5% (38/74 [51.4%] totally followed, 6/74 [8.1%] partially followed, p <0.001).In multivariable analysis, recommendations containing ambiguous language were significantly less likely to be followed (adjusted OR 0.16, 95% CI 0.09-0.30, p < 0.001). Other significant predictors of adherence were therapeutic recommendation, and consultant seniority. There was no association between adherence and clinician gender, referring unit, or total number of recommendations. Use of ambiguous language was more frequent in recommendations that were not immediately actionable.

Ambiguous language in ID consults is frequent, and is associated with reduced adherence to recommendations.