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Automated Case Cancellation Review System Improves Systems-Based Practice

  • Education & Training
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Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Background

Accreditation Council for Graduate Medical Education (ACGME) core competencies of systems-based practice and practice-based learning and improvement are difficult to assess, as they are often not directly measurable or observable. Reviewing day-of-surgery cancellations could provide resident learning opportunities in these areas.

Objective

An automated system to facilitate anesthesiology resident review of cancelled cases was implemented on the Preoperative Evaluation Clinic (PEC) rotation at the authors’ institution. This study aims to evaluate its impact on resident education.

Methods

Residents on the PEC rotation during the 6 months preceding (n = 22) and following (n = 13) implementation in 2014 were surveyed about their experience performing cancelled case reviews in order to ascertain the effect of the intervention on their training.

Results

Significant changes were reported in the number of cases reviewed by each resident (p < 0.0001), perceived importance of review (p = 0.03), and ease of review (p = 0.03) after system implementation. There was also an increase in the proportion of cancelled cases reviewed from 17.3 % (34 of 196) to 95.6 % (194 of 203) (p < 0.0001). Non-significant trends were seen in perceived rotation effect on ACGME competencies, including systems-based practice. Several specific improvements to our clinical practice, including the creation of standardized guidelines, arose from these case reviews.

Conclusion

Implementation of automated systems can improve compliance with educational goals by clarifying priorities and simplifying workflow. This system increased the number of cases reviewed by residents and the perceived importance of this review as a part of their educational experience.

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References

  1. Accreditation Council for Graduate Medical Education. ACGME Common Program Requirements, 2013.

  2. Swing, S. R., Clyman, S. G., Holmboe, E. S., and Williams, R. G., Advancing resident assessment in graduate medical education. J. Grad. Med. Educ. 1:278–286, 2009. doi:10.4300/JGME-D-09-00010.1.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Anesthesiology Milestone Group, The anesthesiology milestone project. J. Grad. Med. Educ. 6:15–28, 2014. doi:10.4300/JGME-06-01s1-30.

    Google Scholar 

  4. Simpao, A., Heitz, J. W., McNulty, S. E., et al., The design and implementation of an automated system for logging clinical experiences using an anesthesia information management system. Anesth. Analg. 112:422–429, 2011. doi:10.1213/ANE.0b013e3182042e56.

    Article  PubMed  Google Scholar 

  5. Seufert, T. S., Mitchell, P. M., Wilcox, A. R., et al., An automated procedure logging system improves resident documentation compliance. Acad. Emerg. Med. Off. J. Soc. Acad. Emerg. Med. 18(Suppl 2):S54–S58, 2011. doi:10.1111/j.1553-2712.2011.01183.x.

    Article  Google Scholar 

  6. Ehrenfeld, J. M., McEvoy, M. D., Furman, W. R., et al., Automated near-real-time clinical performance feedback for anesthesiology residents: One piece of the milestones puzzle. Anesthesiology 120:172–184, 2014. doi:10.1097/ALN.0000000000000071.

    Article  PubMed Central  PubMed  Google Scholar 

  7. O’Reilly, M., Talsma, A., VanRiper, S., et al., An anesthesia information system designed to provide physician-specific feedback improves timely administration of prophylactic antibiotics. Anesth. Analg. 103:908–912, 2006. doi:10.1213/01.ane.0000237272.77090.a2.

    Article  PubMed  Google Scholar 

  8. Kooij, F. O., Klok, T., Hollmann, M. W., and Kal, J. E., Decision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. Anesth. Analg. 106:893–898, 2008. doi:10.1213/ane.0b013e31816194fb.

    Article  PubMed  Google Scholar 

  9. Ly, D. P., Jha, A. K., and Epstein, A. M., The association between hospital margins, quality of care, and closure or other change in operating status. J. Gen. Intern. Med. 26:1291–1296, 2011. doi:10.1007/s11606-011-1815-5.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Macario, A., Dexter, F., and Traub, R. D., Hospital profitability per hour of operating room time can vary among surgeons. Anesth. Analg. 93:669–675, 2001.

    Article  CAS  PubMed  Google Scholar 

  11. Dexter, F., Blake, J. T., Penning, D. H., and Lubarsky, D. A., Calculating a potential increase in hospital margin for elective surgery by changing operating room time allocations or increasing nursing staffing to permit completion of more cases: A case study. Anesth. Analg. 94:138–142, 2002. doi:10.1213/00000539-200201000-00026.

    PubMed  Google Scholar 

  12. Dexter, F., Maxbauer, T., Stout, C. M., et al., Relative influence on total cancelled operating room time from patients who are inpatients or outpatients preoperatively. Anesth. Analg. 118:1072–1080, 2014. doi:10.1213/ANE.0000000000000118.

    Article  PubMed  Google Scholar 

  13. Haana, V., Sethuraman, K., Stephens, L., et al., Case cancellations on the day of surgery: An investigation in an Australian paediatric hospital. ANZ J. Surg. 79:636–640, 2009. doi:10.1111/j.1445-2197.2009.05019.x.

    Article  PubMed  Google Scholar 

  14. Krupka, D. C., Sandberg, W. S., and Weeks, W. B., The impact on hospitals of reducing surgical complications suggests many will need shared savings programs with payers. Health Aff. Proj. Hope 31:2571–2578, 2012. doi:10.1377/hlthaff.2011.0605.

    Article  Google Scholar 

  15. Tiwari, V., Krupka, D. C., and Sandberg, W. S., Calculating the true cost of robotic hysterectomy. Healthc. Financ. Manag. 68:80–85, 2014.

    Google Scholar 

  16. Tait, A. R., Voepel-Lewis, T., Munro, H. M., et al., Cancellation of pediatric outpatient surgery: Economic and emotional implications for patients and their families. J. Clin. Anesth. 9:213–219, 1997.

    Article  CAS  PubMed  Google Scholar 

  17. Asimakopoulos, G., Harrison, R., and Magnussen, P. A., Pre-admission clinic in an orthopaedic department: Evaluation over a 6-month period. J. R. Coll. Surg. Edinb. 43:178–181, 1998.

    CAS  PubMed  Google Scholar 

  18. Knox, M., Myers, E., and Hurley, M., The impact of pre-operative assessment clinics on elective surgical case cancellations. Surg. J. R. Coll. Surg. Edinb. Irel. 7:76–78, 2009.

    CAS  Google Scholar 

  19. Seim, A. R., Fagerhaug, T., Ryen, S. M., et al., Causes of cancellations on the day of surgery at two major university hospitals. Surg. Innov. 16:173–180, 2009. doi:10.1177/1553350609335035.

    Article  PubMed  Google Scholar 

  20. Morgan, P. J., Lam-McCulloch, J., Herold-McIlroy, J., and Tarshis, J., Simulation performance checklist generation using the Delphi technique. Can. J. Anaesth. J. Can. Anesth. 54:992–997, 2007. doi:10.1007/BF03016633.

    Article  Google Scholar 

  21. Downing, S. M., Validity: On meaningful interpretation of assessment data. Med. Educ. 37:830–837, 2003.

    Article  PubMed  Google Scholar 

  22. Harris, P. A., Taylor, R., Thielke, R., et al., Research Electronic Data Capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J. Biomed. Inform. 42:377–381, 2009. doi:10.1016/j.jbi.2008.08.010.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Likert, R. A technique for the measurement of attitudes: Science Press, 1932.

  24. Heiberger, R. M. HH: Statistical analysis and data display: Heiberger and Holland, 2014.

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Compliance with Ethical Standards

Funding

Provided by the VUMC Department of Anesthesiology. Additionally, Dr. Wanderer is funded by the Foundation for Anesthesia Education and Research (FAER) and Anesthesia Quality Institute (AQI)’s Health Service Research Mentored Research Training Grant (HSR-MRTG).

Conflicts of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was deemed exempt by the Institutional Review Board at the Vanderbilt University Medical Center.

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Authors and Affiliations

  1. Department of Anesthesiology, Vanderbilt University Medical Center (VUMC), 1301 Medical Center Dr., Nashville, TN, 37232, USA

    Joseph R. Starnes, Matthew D. McEvoy, Jesse M. Ehrenfeld, Warren S. Sandberg & Jonathan P. Wanderer

Authors
  1. Joseph R. Starnes
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  2. Matthew D. McEvoy
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  3. Jesse M. Ehrenfeld
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  4. Warren S. Sandberg
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  5. Jonathan P. Wanderer
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Corresponding author

Correspondence to Joseph R. Starnes.

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This article is part of the Topical Collection on Education and Training

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Starnes, J.R., McEvoy, M.D., Ehrenfeld, J.M. et al. Automated Case Cancellation Review System Improves Systems-Based Practice. J Med Syst 39, 134 (2015). https://doi.org/10.1007/s10916-015-0330-3

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  • DOI: https://doi.org/10.1007/s10916-015-0330-3

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