Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: Understand how residency programs track procedures. Understand how real-time procedure tracking can improve documentation. Understand how real-time procedure tracking can make SIM labs more efficient.

Objective: Tracking of residency procedures is vital to the continued accreditation of Emergency Medicine (EM) residency programs. We sought to determine if a Procedural Achievement Count Evaluation (PACE) score utilization increases ACGME procedural reporting.

Methods: A spreadsheet was created on Google Sheets, which contains the names of all the residents and the ACGME required procedures. The minimum procedural threshold is divided by the total months of residency (36) and then multiplied by each resident’s month in training. We termed the minimal monthly requirement the PACE score. Each resident’s tallied procedures are compared to the PACE value. Residents had open access to the Google Sheets PACE score, attendings were educated monthly, and residents additionally were educated at their semi-annual exams regarding their comparative score. Documented procedures were subdivided into “live” or “SIM”. The number of procedures reported by the third year classes one year before and one year after implementation were tallied. The number of procedures compared to the minimum ACGME requirement were calculated. A two-tailed Wilcoxon Signed-Rank test was utilized, with a p-value of less than 0.05 for statistically significant.

Results: Of the fifteen core procedures reported to the ACGME, 87% (N=13) had increased totals following implementation (P=0.004). The only two procedures without increases were pericardiocentesis and central lines. The average percent increase of all procedures when compared to the minimum requirement was 37% (95% CI, 23,46). The number of live procedures increased in 60% (N=9) of procedures (p=0.06). Additionally, SIM procedures increased in 86% of those procedures that utilized SIM. (N=6 procedures, p=NS). The average percentage increase of SIM procedures was 24% (95% CI, 18,36).

Conclusion: Utilization of a PACE score significantly improved ACGME procedural reporting numbers overall and specifically increased SIM utilization.