Automated Procedure Logs for Cardiology Fellows: A New Training Paradigm in the Era of Electronic Health Records

Abstract

Background: Procedural experience for residents and fellows is critical for achieving competence, and documentation of procedures performed is required. Procedure logs serve as the record of this experience, but are commonly generated manually, require substantial administrative effort, and cannot be corroborated for accuracy.

Objective: We developed and implemented a structured clinical-educational report template (CERT), which automatically generates procedure logs directly from the clinical record.

Methods: Our CERT aimed to replace the post-procedure note template for our cardiac catheterization laboratory and was incorporated into the electronic health record system. Numbers of documented procedures in automated CERT-derived procedure logs over a 1-year post-intervention period (2018-2019) were compared to manual logs and corrected for clinical volume changes. The CERT's impact on fellowship experience was also assessed.

Results: Automated CERT procedure logs increased weekly procedural documentation over manual procedure logs for total procedures (24.2 ± 6.1 vs 17.1 ± 6.8, P = .007), left heart catheterizations (14.5 ± 3.6 vs 10.8 ± 4.2, P = .039), total procedural elements (40.2 ± 11.4 versus 20.9 ± 12.5, P < .001), and captured procedural details not previously documented. The CERT also reduced self-reported administrative time and improved fellowship experience.

Conclusions: A novel CERT allows procedure logs to be automatically derived from the clinical record and increased the number of documented procedures, compared to manual logging. This innovation ensures an accurate record of procedural experience and reduces self-reported non-educational administrative time for cardiology fellows.

Figure 1

Corrected Procedure Volume Reported in Manual vs Automated CERT-Derived Procedure Logs Note: Total Logged Events–all elements captured and recorded in procedure logs, even if more than one occurred in the same procedure (eg, a radial artery access for a coronary angiogram would be considered 2 events, radial access and coronary angiogram); Total Logged Procedures–all individual discrete procedures captured (eg, left heart catheterization, right heart catheterization, pericardiocentesis, etc); NB–the “capture” of specific procedure and procedural elements by manual vs automated CERT-derived procedure logs are displayed in Figure 2.

Figure 2

Manual vs Automated CERT-Derived Individual Procedure and Procedural Element Capture Note: Automated procedures and procedural elements listed were those derived directly from the CERT procedure logs. Manual procedure and procedural elements were those recorded in MedHub, which is prepopulated with a list of common catheterization laboratory procedures, including left and right heart catheterization, percutaneous coronary intervention, mechanical circulatory support, pericardiocentesis, temporary venous pacing, and coronary imaging/physiology studies. There is also an “other” category allowing free-text entry to report any procedure or procedural element that does not fall into the above predefined categories (including but not limited to STEMI, radial access) at the fellow's discretion.