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.

Introduction: Monoclonal antibody (MAB) infusion is the first treatment to manage coronavirus 2019 (COVID-19) in an outpatient setting. Yet increased risk of severe COVID-19 illness may occur from inequities in social determinants of health including access to quality healthcare. Given the safety-net nature of emergency departments (ED), a model that puts them at the center of MAB infusion may better reach underserved patients than models that require physician referral and distribute MAB at outpatient infusion centers. We examined characteristics of two groups of patients who received MAB infusion in the Robert Wood Johnson University Hospital (RWJUH) ED in New Brunswick, New Jersey: 1) patients who tested positive for COVID-19 in the ED and received ED infusion; and 2) patients who tested positive elsewhere and were referred to the ED for infusion. The process for the latter group was similar to the more common national model of patients testing COVID-19 positive in the community and then being referred to an infusion center for MAB therapy. 

Methods: We performed a cross-sectional retrospective health record review of all adult patients presenting to the ED from November 20, 2020–March 15, 2021 who received MAB infusion at RWJUH ED (N = 486). Patients were identified through the electronic health record system by an administrative query, with manual chart review for any additional characteristics not available through the query. We compared the two groups using chi-squared tests for categorical variables and t-tests for continuous variables.

Results: We found higher proportions of Black (18% vs 6% P < 0.001, statistically significant), Hispanic (19% vs 11% P = 0.02), Medicaid (12% vs 9% P = 0.01), and uninsured (17% vs 8% P = 0.01) patients who tested positive for COVID-19 in their ED visit and then received MAB therapy during their visit than patients tested elsewhere in the community and referred to the ED for MAB therapy.

Conclusion: These findings suggest that providing MAB infusion in the ED allows increased access for patients traditionally marginalized from the healthcare system, who may be at risk of longer disease duration and complications from COVID-19.