The use of reflexive rules in an LIS to document resident training in special coagulation testing

1. The use of reflexive rules in an LIS to document resident training in special coagulation testing APIII ‘07 September 9, 2007 Pittsburgh, PA Jeff Bailey MD PhD, Elizabeth Lavallo MT(ASCP), Ruth Natali MT(ASCP), Katharine Downes MD University Hospitals Case Medical Center Case Western Reserve University Cleveland, Ohio

2. Objective • At University Hospitals Case Medical Center (UHCMC), all pathology residents have a 1 month coagulation rotation that includes interpretation of special coagulation testing (hemophilia evaluations, thrombophilia evaluations, bleeding diatheses, etc.) through careful examination of the laboratory results and incorporation of relevant clinical data. • Goal: To track resident activity on the coagulation rotation using the LIS by having residents “sign-out” the coagulation cases that require review and/or interpretations.

3. Rationale • Provide a measure of practice-based resident learning towards fulfilling Accreditation Council for Graduate Medical Education (ACGME) Outcomes Initiative which identified 6 core competencies (July 2002) • emphasis on performance rather than potential • Identify cases where the CPT billing code should receive the “–GC modifier” • Medicare requirement of all teaching hospitals where there was resident involvement (July 1997)

4. Design Requirements • Minimal effort on the resident’s part. • Minimal programming or alteration of our LIS. • UHCMC currently uses text-based version of SoftLab (Softlab, SCC Soft Computer Inc, Clearwater, FL, USA) —design does not allow for tiered sign-out (verification).

5. Implementation • Generated a dummy test called ZRESI to contain the resident’s name as the test value. • This test is added reflexively to any specimen for which any special coagulation test has been ordered. • Set a default value of period (.) to denote no resident involvement. • Residents set value to their name if they reviewed or worked on the case. • Minimizes resident entry by tagging specimen rather than individual tests. • Implemented April 1, 2007.

6. Work Flow – Text based

7. Templates to generate test lists

8. SCOAG work list

9. 012345678 DOE, JOHN X. Work Flow - ZRESI entry.

10. Resident Statistics

11. Test Statistics

12. Future Directions • Continued monitoring and verification of resident activity on the coagulation rotation (examine what resident’s aren’t signing out). • Expansion to other areas of clinical pathology where tracking of resident activity is desired—e.g. Hematopathology resident reviews of CBCs, body fluids and crystals. • Addition of a comment field for assessment of resident’s signout--compentency.

13. Acknowledgements • CAP Foundation Travel Award • University Hospitals Case Medical Center Pathology Residency Program • Cleveland City Wide Transfusion Medicine Fellowship