The use of reflexive rules in an LIS to document resident

training in special coagulation testing

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

APIII ‘07September 9, 2007

Pittsburgh, PA

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.

Rationale

1. 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

2. 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)

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).

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.

Work Flow – Text based

Templates to generate test lists

SCOAG work list

Work Flow - ZRESI entry.

DOE, JOHN X.012345678

Resident Statistics

SPECIMEN # TEST #RESIDENT #1 107 175RESIDENT #2 1 6RESIDENT #3 100 197RESIDENT #4 97 190RESIDENT #5 7 15

Test Statistics

TOTAL RES #1 RES #2 RES #3 RES #4 RES #5THROMBOPHILIA 96 31 31 34

LUPUS 83 29 27 26 1HEMOPHILIA 44 17 1 10 15 1

COAGULOPATHY NOS 35 13 12 8 2LOVENOX 28 8 10 7 3

VON WILLEBRAND 26 9 10 7

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.

• CAP Foundation Travel Award

• University Hospitals Case Medical Center Pathology Residency Program

• Cleveland City Wide Transfusion Medicine Fellowship

Acknowledgements