Appl Clin Inform 2021; 12(03): 479-483
DOI: 10.1055/s-0041-1730323
Case Report

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System

Holly B. Ende
1   Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Michael G. Richardson
1   Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Brandon M. Lopez
1   Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Jonathan P. Wanderer
1   Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
2   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations
Funding None.


Background The Accreditation Council for Graduate Medical Education establishes minimum case requirements for trainees. In the subspecialty of obstetric anesthesiology, requirements for fellow participation in nonobstetric antenatal procedures pose a particular challenge due to the physical location remote from labor and delivery and frequent last-minute scheduling.

Objectives In response to this challenge, we implemented an informatics-based notification system, with the aim of increasing fellow participation in nonobstetric antenatal surgeries.

Methods In December 2014 an automated email notification system to inform obstetric anesthesiology fellows of scheduled nonobstetric surgeries in pregnant patients was initiated. Cases were identified via daily automated query of the preoperative evaluation database looking for structured documentation of current pregnancy. Information on flagged cases including patient medical record number, operating room location, and date and time of procedure were communicated to fellows via automated email daily. Median fellow participation in nonobstetric antenatal procedures per quarter before and after implementation were compared using an exact Wilcoxon-Mann-Whitney test due to low baseline absolute counts. The fraction of antenatal cases representing nonobstetric procedures completed by fellows before and after implementation was compared using a Fisher's exact test.

Results The number of nonobstetric antenatal cases logged by fellows per quarter increased significantly following implementation, from median 0[0,1] to 3[1,6] cases/quarter (p = 0.007). Additionally, nonobstetric antenatal cases completed by fellows as a percentage of total antenatal cases completed increased from 14% in preimplementation years to 52% in postimplementation years (p < 0.001).

Conclusion Through an automated email system to identify nonobstetric antenatal procedures in pregnant patients, we were able to increase the number of these cases completed by fellows during 3 years following implementation.

Protection of Human and Animal Subjects

This quality improvement study was determined to be exempt by the Human Research Protections Program at Vanderbilt University Medical Center. No human and/or animal subjects were included.

Supplementary Material

Publication History

Received: 24 February 2021

Accepted: 19 April 2021

Article published online:
26 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

  • References

  • 1 Education ACfGM. Accessed December 8, 2020 at:
  • 2 Huang SY, Lo PH, Liu WM. et al. Outcomes after nonobstetric surgery in pregnant patients: a nationwide study. Mayo Clin Proc 2016; 91 (09) 1166-1172
  • 3 Bonnet MP. Sedation and anaesthesia for non-obstetric surgery. Anaesth Crit Care Pain Med 2016; 35 (Suppl. 01) S35-S41
  • 4 Dalal AK, Schaffer A, Gershanik EF. et al. The impact of automated notification on follow-up of actionable tests pending at discharge: a cluster-randomized controlled trial. J Gen Intern Med 2018; 33 (07) 1043-1051
  • 5 Weingart SN, Yaghi O, Barnhart L. et al. Preventing diagnostic errors in ambulatory care: an electronic notification tool for incomplete radiology tests. Appl Clin Inform 2020; 11 (02) 276-285
  • 6 Williams C, Rao A, Ziemba JB, Myers JS, Patel N. Text messaging real-time COVID-19 clinical guidance to hospital employees. Appl Clin Inform 2021; 12 (02) 259-265
  • 7 Jacobs BR, Crotty E, Conway E. et al. Computerized provider order entry with pager notification improves efficiency in STAT radiographic studies and respiratory treatments. Appl Clin Inform 2010; 1 (01) 19-31
  • 8 Naik ND, Abbott EF, Aho JM. et al. The ACGME case log system may not accurately represent operative experience among general surgery interns. J Surg Educ 2017; 74 (06) e106-e110
  • 9 Anyanwu EC, Mor-Avi V, Ward RP. Automated procedure logs for cardiology fellows: a new training paradigm in the era of electronic health records. J Grad Med Educ 2021; 13 (01) 103-107
  • 10 Mai MV, Orenstein EW, Manning JD, Luberti AA, Dziorny AC. Attributing patients to pediatric residents using electronic health record features augmented with audit logs. Appl Clin Inform 2020; 11 (03) 442-451
  • 11 Starnes JR, McEvoy MD, Ehrenfeld JM, Sandberg WS, Wanderer JP. Automated case cancellation review system improves systems-based practice. J Med Syst 2015; 39 (11) 134