The use of reflexive rules in an LIS to document resident training in special coagulation testing
Katharine A Downes None, MD, DSc, DVM, CRNP, MA, BS, AOCN, ACSW, ART, AS, ASN, BA, JD, BDS, BVSc, CCRC, CMA, CTR, DMS, DrPH, FACP, FACS, FRCP, DDS, FRCS, LDS, LPN, LSW, MBA, AAS, AND, ATC, LDN, CS, FACC, ASCP, DABR, DMD, DO, BSN; Case Western Reserve University and University Hospitals of Cleveland; Elizabeth ASCP; University Hospitals of Cleveland; Jeffrey A Bailey MD, PhD; Case Western Reserve Univiersity and University Hospitals of Cleveland; Ruth Natali ; University Hospitals of Cleveland;
Content:
Current Accreditation Council for Graduate Medical Education (ACGME) standards emphasize practical measures of resident performance, but documenting resident activities is often difficult due to the lack of built-in methods for resident sign-out within many laboratory information systems (LIS). Modifying LIS software to document resident effort usually exceeds the expertise available at most sites. To overcome this, we have developed a simple method in the LIS to document resident effort that requires no modification of underlying LIS software.
Technology:
LIS (SoftLab, SCC Soft Computer Inc, Clearwater, FL, USA); Excel Spreadsheet (Microsoft Corp., Redmond, WA, USA).
Design:
To address the lack of a direct method to track resident sign-out activities without the need for LIS customization, we created a dummy test called ZRESI to which a residents name can be added as the result. The ZRESI test is reflexively ordered based on a set of rules capturing all special coagulation tests from all inpatient and outpatient settings served by the laboratory. The ZRESI test is visible only to laboratory users. The default value for the test is a period indicating no resident . A rule was set to avoid back-ordering the test prior to implementation. When a resident has reviewed a test result, he/she simply enters his/her name using shortcut keys. Data are extracted from the LIS using a basic SQL query that returns the residents name and all associated tests; these data can be exported into a spreadsheet for analysis.
Results:
Data generated by this method are used to analyze and document the breadth of resident experience in coagulation testing. Setting up the resident tracking as a separate test is advantageous as multiple current tests do not need to be modified to incorporate tracking information and is quicker for the residents as they need to enter their names only once per specimen, rather than for each test on a given specimen.
Conclusion:
Using a dummy test provides a simple, efficient method to capture resident effort, which provides data for feedback and documenting resident participation. Such data provide objective measures consistent with ACGME goals of system based learning.
