Case Log Monitoring: Ensuring Your Program and

Transcription

Case Log Monitoring:
Ensuring Your Program and
Residents Meet Their Case Log
Requirements
Carl Backer, MD RC, Vice Chair
HelenMari Merritt, MD RC Resident Member
Donna L. Lamb, MBA, BSN ACGME Executive Director
Thoracic Surgery Director’s Association Meeting
Phoenix, AZ
23 January 2016
© 2016 Accreditation Council for Graduate Medical Education (ACGME)
Introductions
HelenMari Merritt, DO
• U Nebraska, Cardiac Faculty and APD (Ind)
• I6 at UTHSC San Antonio (the first!)
• Past Resident Member of RC-TS
Donna L. Lamb, MBA, BSN
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Ex Dir -Thoracic, General, and Plastic Surgery
Prior DIO and GME/Hospital Administrator
Old CT/Trauma/NICU Nurse
Completing Doctorate - Sept 2016!
Disclosures
No financial conflicts to disclose
Objectives
 How are cases counted?
 Is this data flowing to the RRC?
 How are programs held responsible if
residents do not meet requirements for
graduation?
 How are these numbers confirmed?
 How can RRC encourage more frequent
monitoring to ensure resident eligibility for
Boards?
Case Logs
How are cases counted?
HelenMari Merritt, DO
• For any MRN/case code, multiple
CPTs may be entered - only ONE is
counted as primary procedure.
• Residents decide which code is
counted as primary for a procedure.
• All CPTs should be entered - only
one may be chosen as primary
designation.
• The “Minimums Report” helps to gage
which category will be most useful.
• The primary code may be changed
any time prior to final submission.
What can be counted twice?
The ABTS has designated instances
where multiple CPTs may be tracked
for a single case. These can be found
on the ABTS website.
https://www.abts.org/root/home/certification/
operative-requirements.aspx
• Cardiac Examples
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Re-operations
Conduit preparation
Tricuspid if performed w/CABG
Aortic Procedures
TEVAR
Arrhythmia Surgery
IABP, ECMO, VAD, & OHT
Pacemakers
• Thoracic Examples
• EPP (lung/pleura)
• Chest wall resection
• Sleeve lobectomy and carinal
pneumonectomy
• Mediastinal Assessment
• VATS procedures
• Endoscopic procedures
• Lung transplantation
CLARIFICATION
Only 1 pneumonectomy can be doublecounted for bilateral lung transplant.
Residents must choose how to log this
case (ie: as a transplant or as a
pneumonectomy)
CLARIFICATION
There is presently no ABTS
requirement for transplantation.
Transplant implant can be counted for
Major Lung or Airway
First assistant cases only are tracked in
the congenital category.
How do residents double
count cases?
Each CPT must be logged as a
separate case to claim credit.
• No rule that a single MRN can not be used
>1 time (like in GS);
• However, residents may also add -01, -02
to the end of an MRN to designate a
separate case as well.
count cases?
EX: Re-do Sternotomy with CABG and
MAZE procedure.
Three separate cases must be entered for
MRN 56789.
• Case ID #1: 56789 CABG CPT 33533
• Case ID #2: 56789-01 MAZE CPT 33254
• Case ID #3: 56789-02 Re-do Sternotomy CPT
33530
count cases?
EX: VATS Lobectomy and
mediastinoscopy
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#1 VATS
#2 Lobectomy
#3 Mediastinoscopy
#4 Bronchoscopy (if performed)
Resident Monitoring
Residents must ensure all cases are
appropriately captured.
Resident Monitoring
There are still some catches in the
system.
EX: VATS Decortication is one option for a
CPT
• This does not automatically count as a pleural
case (decortication) and VATS case, though
the CPT implies it will.
Residents will need to enter two separate cases.
Resident Starting Before 2012
All I6 Residents in their PGY5 and
PGY6 years presently.
The current ACGME “Minimums Report”
does not apply completely to these
residents.
Case minimums listed on ACGME Thoracic
Surgery webpage
Resident Starting Before 2012
These residents and PDs should crosscheck the ABTS to verify they have met
the 2007-2012 requirements
https://www.abts.org/root/home/certification/operative-requirements.aspx
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No FLS requirement.
No Critical Care requirement
No Simulation requirement
In general, requirements are less specific.
I6 Residents years 1-3
Operative Requirements:
• 375 operations averaged over 3 years
• 125 must be CT cases
• 50 of these may be component cases
• 150 ABS index cases
(www.abts.org)
I6 Residents year 1-3
In addition to semiannual evaluation, you
may wish to incorporate a “check point”
between PGY-3 and PGY-4.
This is otherwise difficult to track, but can be
done by changing the date-range on the
reports screen
ACGME Minimums
Guide to track resident’s progress.
ACGME Minimums
Recommendations for Residents
from an ex-Resident
• Keep a record of cases for possible
discrepancies.
• Save a comprehensive ACGME report at
least once a month.
Case Logs
Is this data flowing to the RC?
Donna L. Lamb, Executive Director
Thoracic Surgery, General Surgery, Plastic Surgery
Is this data flowing to the RC?
Yes, but…
The RC will begin to review case log
data beginning January 2017 for the
2016 graduate residents.
The RC will not see your current resident
case logs.
Case Logs: RC Assessment
Example of Surgery as there
are no minimums reports
available for thoracic surgery.
Case Logs: RC Assessment
Pink box means missed minimum
Case Logs
Program Accountability?
Program Accountability
Operative Experience is outlined in the
program requirements beginning with
IV.A.5.g) and is defined by the ABTS
Curriculum Organization and Resident Experiences
Residents must have a minimum operative
experience that includes…..
Programs are expected to routinely
monitor resident/fellow case logs.
Case logs are monitored on ALL
graduating residents with each annual
review
Program Accountability: Monitoring
Case Logs
What happens if my
residents/fellows are deficient in
meeting the minimum case log
requirements?
Case Logs:
Programs may have:
 Clarifying Information request
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Formal request for specific information
Has a due date (hard stop)
May defer accreditation decision
Will be considered by the RC to determine
further needs/action
 Resolve/Investigate further/RC Review
Case Logs:
Programs may have:
 Areas for Improvement
 “Heads up” that the RC is concerned about
something
 Does not require a response
 Not connected to a program requirement
Case Logs:
Programs not in compliance may receive:
 Citation
 Articulates an area of non-compliance
 Must have a justifying program requirement
 Requires a response by the program
 Response should include how program
investigated issue, will ensure compliance,
routinely oversee the issue, and sustain
improvement
 Considered by the RC at the next annual
meeting
Case Logs:
Programs w/ citations may also have:
 Progress Report
 Result from citations and are a formal request
for a response
 Requires a response by the program
 Response should include how program
investigated issue, will ensure compliance,
routinely oversee the issue, and sustain
improvement
 Considered by the RC at the next annual
meeting
Can RC Encourage Frequent
Monitoring?
Yes
Requirement V.A.2.b).(4) states the
program must provide each resident with
documented semiannual evaluation of
performance with feedback.
• Case logs should be reviewed as part of the
comprehensive semiannual evaluation by the
CCC.
Confirmation of Case Logs
Honor System for residents and PDs
Program Requirement: IV.A.5.g.6(a & b)
The resident must be involved in the preoperative
planning and postoperative care of the patient, as
well as perform the key steps of the surgery to count
as a primary case.
Case Logs: 4+3 programs
Problems for these programs:
 Incoming residents cases being logged
into General Surgery (GS) case log
 GS case log mapping different/more narrow
 Some cases that do not count for GS need to
count for TS
 GS reports do not align with the needs of the
TS report
Problems for these programs:
 Availability of case log
 Resident case log records split between
programs
 GS case log not available in ADS once resident
moves into the TS program
 Residents printing out paper logs to provide to
program
 No comprehensive record of operative
training for resident
Solution:
 Migrate the GS case log into the TS case
log beginning 01 January 2016
 Once resident is “claimed” by TS program:
 Program must contact [email protected]
to transfer the data
**Of note – some CPT codes map to more than
one operative category for TS
 Working to identify and adjust at time of transfer
Case Logs - The Transition
• Initial Roll out
• Correct mapping to
correct minimum
• Report to ABTS
ACGME Resources
Donna L. Lamb, BSN, MBA--Executive Director
[email protected] / 312.755.5499
Cathy Ruiz, MS--Senior Accreditation Administrator
[email protected] /312.755.5495
Olivia Orndorff--Accreditation Administrator
[email protected] / 312.755.7491
June Thiele-Accreditation Assistant
[email protected] /312.755.5038
[email protected]
Questions?
Thank you

Case Log Monitoring: Ensuring Your Program and

Transcription

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