Use of the Electronic Health Record to Track Continuity of Care in Neurological Surgery Residency

Abstract

Background Continuity of care in neurological surgery includes preoperative planning, technical and cognitive operative experience, and postoperative follow-up. Determining the extent of continuity of care with duty hour limits is problematic. Objective We used electronic health record data to track continuity of care in a neurological surgery program and to assess changes in rotation requirements. Methods The electronic health record was surveyed for all dictated resident–neurological surgery patient encounters (excluding progress notes), discharge summaries, and bedside procedures (July 2009–November 2011). Encounters were designated as preoperative, operative, or postoperative and were grouped by postgraduate year (PGY)–1 through PGY-6. Results A total of 6382 dictations were reviewed, with 5231 (82.0%) pertinent to neurological surgery. Of the 1469 operative notes, 303 (20.6%) had a record of an encounter with the operating resident in either a postoperative or preoperative setting. Preoperative encounters totaled 10.1% (148 of 1469); postoperative, 5.1% (75 of 1469); and encounters with both were 5.4% (80 of 1469). Continuity of care was as follows: PGY-1, 13.8% (4 of 29); PGY-2, 17.4% (26 of 149); PGY-3, 29.0% (36 of 124); PGY-4, 24.8% (73 of 294); PGY-5, 28.8% (109 of 379); and PGY-6, 11.1% (55 of 494). One of the highest continuity rates was observed in a rotation specifically constructed to enhance continuity of care. Conclusions The electronic health record can be used to track resident continuity of care in neurological surgery. The primary operating resident saw the patient in nonoperative settings, such as general admission, clinic visitation, or consultation in 20.6% (303 of 1469) of cases.

Uses of Electronic Health Record Data to Measure the Clinical Learning Environment of Graduate Medical Education Trainees: A Systematic Review

“…Following full-text review, an additional 154 articles lacked inclusion criteria and were excluded. Our final review contained 86 articles 6–91 (for complete extracted data, see Supplemental Digital Appendix 2 at http://links.lww.com/ACADMED/B430).…”

“…Systems-based practice entails the “awareness of and responsiveness to the larger context and system of health care … as well as the ability to call effectively on other resources to provide optimal health care.” 1 Thirteen articles (15%) clustered within this competency, covering 2 themes: continuity of care (12 articles) and panel size (1 article). Continuity of care is important to multiple stakeholders as a driver of patient outcomes, patient satisfaction, physician satisfaction, and trainee education 17,52–62 ; however, it is variably defined. 93 Articles from primary care specialties defined continuity either from the physician perspective (proportion of visits with “my patients”) 52,53,55–57,59,60,62 or from the patient perspective (proportion of visits with “my doctor”), 17,54,61 using EHR-recorded relationships.…”

“…1 Thirteen articles (15%) clustered within this competency, covering 2 themes: continuity of care (12 articles) and panel size (1 article). Continuity of care is important to multiple stakeholders as a driver of patient outcomes, patient satisfaction, physician satisfaction, and trainee education 17,[52][53][54][55][56][57][58][59][60][61][62] ; however, it is variably defined. 93 Articles from primary care specialties defined continuity either from the physician perspective (proportion of visits with "my patients") 52,53,[55][56][57]59,60,62 or from the patient perspective (proportion of visits with "my doctor"), 17,54,61…”

Enhanced Scheduling Support to Improve Continuity of Care in a Resident Training Clinic

“…This may be due to less consistent maintenance of correct resident assignments in the EHR in traditional clinics, which has been recognized as an important component in establishing continuity. 9,11 Limitations of this study include the use of a single residency program, which limits generalizing to programs with different clinic settings and procedures. The interprofessional nature of IMPACcT and its small size (10 residents versus 57 residents) may have affected results.…”

“…8 In our experience, future primary care appointments are typically discussed between the physician and the patient, and the patient is given the responsibility of arranging the subsequent visit. Few studies have examined the relationship between scheduling and resident continuity in training clinics, 9,10 and to our knowledge, no study has examined enhancing scheduling staff.…”