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Development of a System to Identify Antenatal Non-Obstetric Surgery Cases: Meeting Fellowship Program Educational Goals and ACGME Requirements
Abstract Number: SAT-24
Abstract Type: Original Research
BACKGROUND: Experience providing anesthesia for antenatal non-obstetric/non-fetal (NONF) surgery is not only an ACGME OB Anesthesiology fellowship program requirement, its importance stems from the spectrum of surgeries performed on pregnant women, and anesthetic/surgical effects on mother and fetus.(1) ACGME minimum case requirements for high-risk maternal and fetal deliveries, vaginal and cesarean, are routinely exceeded by a wide margin, as they are the exclusive domain of OB anesthesiologists. In contrast, antenatal case requirements are often just met, being performed away from L&D, often by non-subspecialists. Our aim was to increase advance identification of non-OB antenatal surgery cases in order to augment fellow participation in these educationally valuable cases.
METHODS: Three sequential data-driven interventions:
I-1: 9/2013-2/2014: “Agreements to notify” – clinical scheduler/leader-dependent; pregnant patients scheduled for non-OB surgery; requests for pre-op fetal assessment.
I-2: 11/2014-2/2015: “Automated email notify” – daily pre-op database query for words indicating pregnancy; +hCG results.
I-3: 6/2016: Enhanced sensitivity of automated notify – code revised; early morning database query; optimized hCG threshold level.
OB anesthesia fellow case logs (accurate & complete from AY 2013-14) were queried for antenatal surgical procedures. Antenatal case types: external cephalic version; cervical cerclage; fetal surgery/EXIT; and NONF.
RESULTS: Number of fellows: one in each of AY2013-14, AY2014-15, AY2015-16; two in AY2016-17. Fellow participation in antenatal procedures is presented in 6-month epochs (Figure). I-1 had no impact on case numbers. Fellows participated in 15 cases in AY2013-14, 13 in AY2014-15, including only 4 NONF cases in both years combined. Similar case numbers were observed in 1st half AY2015-16 (7 total, 2 NONF), prior to I-2. After I-2, total cases (12) rose sharply, attributable to increase in NONF cases (6). Following I-3, a further increase (total 27) occurred in 1st half AY2016-17, owing to increases in cerclage (10) and NONF (11). Logged cases in excess of required 10 per fellow were 5 (AY13-14), 3(AY14-15), and 9(AY15-16). In 1st half AY2016-17, case numbers for two fellows are already 18 and 9.
CONCLUSION: Through an iterative improvement process, we were able to effect nearly a four-fold increase in our fellow’s case experience using an automated IT solution.
REF: 1. Reitman. Br J Anaesth 2011;107: i72