134 - Utilizing the Electronic Health Record to Automate Procedure Logs for Pediatric ICU Fellows

Poster Number: 134
Publication Number: 134.2726

Background: Fellows training in pediatric critical care (PCCM) are expected by the American College of Graduate Medical Education (ACGME) to be able to “perform all medical, diagnostic, and surgical procedures considered essential for the area of practice.” Per the ACGME, these procedures include peripheral arterial catheterization (PAC), central venous catheterization (CVL), endotracheal intubation, thoracostomy tube placement, resuscitation and procedural sedation. Trainees are expected to both document the procedure in the Electronic Health Record (EHR) and in their fellowship online “procedure log.”

Objective: Though utilized in some other training specialties, utilizing the EHR for procedure tracking has not been published for pediatric or adult ICU fellowship training programs. We hypothesized that this two-step task leads to inaccurate numbers of reported procedures with fellows given task redundancy and competing priorities. The objective of this study was to evaluate the accuracy of EHR-derived procedure logs as compared to the current standard logging method.

Design/Methods: We queried procedure notes for PACs, CVLs, endotracheal intubations, chest tubes, and lumbar punctures from our hospital EHR from academic years (AY) 2017-2018 through 2022-2023. We compared procedure numbers for graduating critical care fellows from the EHR to fellows’ procedure logs documented in NewInnovations online log. Descriptive statistics were analyzed using median and interquartile ranges and significance was determined using Wilcoxon rank-sum test.

Results: 34 critical care fellows over 9 academic years were included. Procedures were totaled individually from the start of fellowship through graduation. For PACs, the median number of procedures logged was 31.5 (IQR 23-44) as compared to 38 (IQR 24-51) for EHR-derived logs (p-value =0.36282). For CVLs, the median logged was 13 (IQR 9-17) versus 16 (IQR 13-34) for the EHR-derived (p-value < 0.01). For chest tubes, the median logged was 2.5 (IQR 1-4) versus 3 (IQR 1-4) for the EHR-derived (p-value =0.32708). For lumber puncture, the median logged was 2.5 (IQR (1-3) versus 2 (IQR 1-4) for the EHR-derived log (p-value=0.8493). Endotracheal tubes were excluded due the inherent discrepancy secondary to intubations performed during anesthesia cases, which are logged separately.

Conclusion(s): This data verifies that EHR-based procedural logging can accurately pull data on fellow’s procedures for documentation. If enacted, this innovation could minimize trainee and administrator burden, improve the accuracy of procedure logs, and promote professional documentation of all procedures.