WEB BASED RESIDENT CASE-LOG ENTRY SYSTEM

ALL anesthesiology residents are expected to enter their own case data via the ACGME Web-based Resident Case Log System.  Detailed instructions for this system are available either on the ACGME web site itself or here in the housestaff manual.  You may use the links below to access the web-based case log system.  Prior to using the system, you will need to get your username and password information from Joanie Nyland, Debbie Brown, or Dr. Mahla. 

Accurate and complete case logs are essential for your future career.  Hospitals are now granting clinical privileges according to your documented experiences with different types of cases and monitoring modalities.  Finally, the program director must provide evidency to the ACGME that this program has appropriate resources to provide needed experience to its trainees.  Accordingly, the following policies MUST be followed with respect to ACGME Case Log Data Entry:

• You must update your case log at least monthly.  The program director will randomly monitor compliance with case entry (a report is available from the ACGME web site).  Residents who are more than two or more months behind in entering data will LOSE CREDIT FOR TRAINING.  The amount of time lost will be one month less than the number of months the resident has failed to enter their case data.  For example, if a resident has not entered any data for 3 months, he / she will lose 2 months of credit for training. 
• You must be aware of the ACGME Program Requirements for numbers of cases in each category.  
• While the program's administrative staff and program director will design your schedule and case assignments so that you will have the appropriate opportunity to get your required cases, it is partly your responsibility to make certain that the program director and administrative staff are aware when you have a case deficit.   The program director does review the logs, but such reviews are meaningless when the case logs are incomplete or inaccurate.
• Your case logs will be reviewed individually with the program director at the end of your CA-2 year to make certain you have met all your case requirements prior to choosing your electives for the CA-3 year.  If you have significant deficits in any areas, some of your CA-3 rotations will not be elective in order to make up your deficits. 

 Those of you who violate these policies will be subject to the following administrative sanctions:

• Residents who are more than two or more months behind in entering data will LOSE CREDIT FOR TRAINING.  The amount of time lost will be one month less than the number of months the resident has failed to enter their case data. 
• Residents who actually lose credit for a month or more of training will be put on administrative probation.
• CA-3 residents who do not meet their case requirements by January prior to graduation will be removed from their elective rotation and given needed cases.  The elective rotations will be given to more junior residents who are appropriately entering their cases into the ACGME system.
• Residents whose case logs are not fully up to date on April 15 prior to beginning their CA-3 year will NOT be allowed to participate in the CA-3 Rotation Lottery system.

Links to access the system:

ACGME Case Log LOGIN Page

ACGME Case Log Instructions

  The ACGME, RRC and the ABA do not provide detailed instructions as to exactly how these online forms should be completed. So that this Department may be internally consistent, please apply the following rules claiming credit for cases in the ACGME system.

Definition of case involvement: Any case in which you have significant involvement should be documented on your form. Significant involvement may be defined as:

• The resident assigned to a case and involved from induction to emergence from anesthesia.
• A resident with a significant assisting role may also claim credit for case involvement (e.g. senior resident on a case performed by a junior pairee). Only claim credit for inserting lines or special intubation techniques, etc. if you actually performed the procedure. This would apply, for example, to senior residents paired with junior residents who are doing most of the procedures under the supervision of the senior resident.
• A resident who relieves another resident from a case and has significant involvement. Significant involvement may be defined as over one hour time or involvement with a significant procedure or event in the case (e.g. massive hemorrhage, unexpected placement of a PA catheter, etc.)

A1. Region: Carefully analyze what region is involved with the surgical procedure. This is very important for our program information analysis when we try to determine whether we have enough of a given type of procedure to meet RRC requirements. Please note that the vast majority of your cases will fall under the OTHER category.  Note, it is definitely possible to have a case involve more than one region.  For example, a thoracoabdominal aneurysm repair NOT utilizing bypass will fall in BOTH the intrathoracic without CPB region and the major vascular region).

• Intrathoracic with CPB:  Any intrathoracic case utilizing cardiopulmonary bypass.  This category includes all cardiac procedures as well as intrathoracic aortic procedures utilizing bypass.
• Intrathoracic without CPB:  Any intrathoracic case non utilizing cardiopulmonary bypass.  This category includes any open heart procedure not utilizing CPB, any thoracic aortic procedure not utilizing bypass, any type of total esophagectomy via abdominal or via a thoracotomy, any esophageal surgery, any thoracotomy, any thoracoscopic procedure (note, spine procedures and sympathectomies are now done via this route), and any other type of procedure where the chest is entered (includes rigid bronchoscopies, mediastinoscopy). 
• Major vascular:  Any procedure involving a major blood vessel.  This includes all extremity revascularization procedures, carotid vascular surgery, thoracic and abdominal aortic surgery, iliac artery surgery and all endovascular surgery.  This category does NOT include vascular access procedures (e.g. for renal dialysis) or repair of vascular access.
• Intracranial vascular:  All intracranial surgery involving any of the following:  aneurysms, arteriovenous malformations, cavernous malformations.  This does include neurosurgical endovascular procedures. 
• Intracranial non-vascular:  All other intracranial procedures.  To qualify for an open intracranial procedure, a craniotomy flap or craniectomy must be performed.  Ventriculoperitoneal shunt procedures do NOT qualify and should be entered as "OTHER".  Beginning July 2008, the intracranial vascular category will be discontinued and will be counted just as an intracranial procedure.  Again, INCLUDE ENDOVASCULAR NEUROSURGERY OF ALL TYPES.
• Vaginal delivery:  All types of analgesia provided for the management of labor pain belong in this category.  Even if the patient ultimately has a c-section, you should take credit for an anesthetic for vaginal delivery.  Thus, if you manage a patient for labor pain and she subsequently has a c-section, you should take credit for BOTH a vaginal delivery and a c-section.  Combined spinal / epidural techniques (CSE) count as BOTH techniques. 
• C-section:  All elective, urgent, and emergent c-sections should be counted in this category.  Note, except for patients coming in for elective c-section, all patients counted in this category should also be counted in vaginal delivery if you provided labor analgesia via any technique.  Also please note, if the patient has a c-section under epidural or spinal anesthesia, you should also claim credit for an epidural or spinal anesthetic for a surgical procedure.
• Major Trauma:  Includes patients undergoing surgery for complex, life-threatening injuries.  Examples of these injuries would include trauma associated with car crashes, falls from high places, penetrating wounds, industrial of farm accidents, and assaults.  Burns covering more than 20% of the body surface are also count in this category.
• Other:  Any anesthetic provided that does not fit in one or more of the above categories.

A2. Situation: Only mark this if the case is ambulatory or trauma. A case is defined as ambulatory if the patient is not admitted to the hospital following surgery. A case is defined as trauma if the procedure is the INITIAL procedure following the traumatic event and the procedure is performed for the purpose of repairing damage caused by the trauma.  All trauma cases requiring urgent / emergent surgery should be counted.  This category is now defined by severity and should only include major, life threatening injuries such as occur associated with car crashes, falls from high places, penetrating wounds, industrial and farm accidents, and assaults.  Burns covering > 20% of body surface area are now also included in this category.

A3. Technique for Anesthesia (NOT PAIN): This refers to anesthetic technique OR TECHNIQUES used to render the patient insensible to pain for surgical procedures. Anesthetic techniques used for the workup or treatment of pain will be documented under PAIN MANAGEMENT (see below). General anesthetics or cases of Monitored Anesthesia Care are classified together. Nerve block refers to any single shot nerve block or continuous catheter block that an anesthesiologist used to render the patient insensible to pain during surgery or postoperatively. Nerve blocks or field blocks performed by the surgeon do not count.  ALL EPIDURALS provided for laboring patients or for cesarian section need to be marked in this section.  They are not counted as techniques for pain management.  All procedures done in the block room which contribute to intraoperative anesthetic management should be counted in this section.  They may also be counted for postoperative acute pain management if the block is used for both purposes (in the same category as the intraoperative use - i.e. nerve block, epidural, etc).

A4. Procedures / Techniques: These should be marked anytime YOU INITIATED any of the procedures or techniques. If lines were placed, for example, in an ICU patient prior to coming to the operating room, you should NOT take credit for their placement. Please note that TEE (transesophageal echocardiography), EP (evoked potentials), and EEG (electroencephalogram or Bispectral Index (BIS) monitoring) should be marked whenever they are used on your patient. It is likely that you are NOT doing the monitoring yourself. These are meant to only document exposure to the monitoring techniques.

• Residents assigned to the ICU may do any of these procedures. You need to document every line, intubation, or involvement with special diagnostic EEG / EP or TEE studies. You should keep an up-to-date running tally of all of these procedures by marking the procedure down immediately after its completion. Attempting to reconstruct a record after a month rotation in an ICU is impossible. Keep a "scratch" form with you at all times in your white coat for this purpose.

A5. Age Group of Patient: The ABA is interested only in documenting exposure to the very young, young, and elderly. This category is self-explanatory. PCA refers to post-conceptual age. 

B1. Pain management Consultations: Any new patient where you provide consultation for the management of acute, chronic, or cancer pain should be counted in this region.  Virtually all patients cared for in the Block Room and many patients on the FSC Regional Rotation should be counted as an acute pain consultation.  Anytime you do a procedure that will help with postoperative acute pain control, you should take credit for an acute pain consultation.  The exact procedures done for any of these patients are counted in section H.  You do not have to perform a procedure to take credit for a consultation.

C1. Pain Procedures:  This category is used to document procedures done for the management of acute (surgical or trauma related) pain, chronic pain or pain related to cancer. The chronic and/or cancer pain procedures are most likely done during your pain management rotations. Acute pain procedures may occur any time. If you place an epidural catheter, make a subarachnoid injection, or do a nerve block that has a significant effect on reducing postoperative pain, pain associated with trauma, or an acute exacerbation of chronic pain, you should take credit for an acute pain procedure. If you are covering the acute pain service and are required to replace, significantly adjust, or repeat a block to provide continuing pain relief, you should take credit for an acute pain procedure. If you are covering the acute pain service and make a significant adjustment in the management of an epidural, wound catheter, or nerve sheath catheter (or similar), you should also take credit for an acute pain consultation. Any catheters placed by the surgeons under direct vision should be defined as "OTHER". Each pain procedure needs first to be identified as acute, chronic, or cancer-related and then further categorized as a spinal injection / catheter, epidural injection / catheter, nerve injection / catheter, or OTHER.

If you have any questions about how these forms are to be filled out, please contact Dr. Mahla (5-0077, Cell phone /pager 352-494-6782). Remember, these online forms MUST be completed within one month of completing a rotation or you may not receive credit for that month. 

Revised June, 2008