Impact of procedure-related complications on patient outcome on a general medicine service

Nettleman, Mary D.; Bock, Megan; Nelson, Ann Pettinger; Fieselmann, John F.

doi:10.1007/bf02600202

Cited by 16 publications

(12 citation statements)

References 13 publications

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“…5,6 Furthermore, the importance of adequate procedural experience is highlighted by the significant effect of procedures on inpatient morbidity and mortality. 7,8 Although debate exists regarding the precise definition of procedural competence, it frequently combines experience with the ability to successfully perform a procedural skill independently and appreciate potential complications. 9,10 In emergency medicine (EM), residents are required to achieve competence in an extensive number of procedural skills.…”

Section: Ré Sumémentioning

confidence: 99%

Emergency medicine procedural skills: what are residents missing?

Petrosoniak¹,

Herold²,

Woolfrey³

2013

CJEM

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Objective: This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies. Methods: A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Program directors rated the importance and experience required for competence of 45 EM procedural skills. EM residents reported their experience and comfort in performing the same procedural skills. Results: Thirteen program directors and 86 residents responded to the survey (response rate of 100% and 37%, respectively). Thirty-two (70%) procedures were considered important by . 70% of program directors, including all resuscitation and lifesaving airway procedures. Four procedures deemed important by program directors, including cricothyroidotomy, pericardiocentesis, posterior nasal pack for epistaxis, and paraphimosis reduction, had never been performed by the majority of senior residents. Program director opinion was used to categorize each procedure based on performance frequency to achieve competence. Overall, procedural experience correlated positively with comfort levels as indicated by residents. Conclusions: We established an updated needs assessment of procedural skills training for Canadian Royal College EM residency programs. This included program director opinion of important procedures and the performance frequency needed to achieve competence. However, we identified several important procedures that were never performed by most senior residents despite program director opinion regarding the experience needed for competence. Further study is required to better define objective measures for resident competence in procedural skills.

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Section: Ré Sumémentioning

confidence: 99%

Emergency medicine procedural skills: what are residents missing?

Petrosoniak¹,

Herold²,

Woolfrey³

2013

CJEM

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“…Evidence suggests more procedural experience is associated with reduced complications5–8, perhaps leading graduating Internal Medicine residents to report feeling comfortable performing inpatient bedside procedures9–11. However, few articles have examined residents’ experiences and perceptions around supervision during the years of their training, or how often peer-to-peer supervision may produce unsafe (or at least uncomfortable) clinical situations.…”

Section: Introductionmentioning

confidence: 99%

Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency

et al. 2010

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BACKGROUNDAt teaching hospitals, bedside procedures (paracentesis, thoracentesis, lumbar puncture, arthrocentesis and central venous catheter insertion) are performed by junior residents and supervised by senior peers. Residents’ perceptions about supervision or how often peer supervision produces unsafe clinical situations are unknown.OBJECTIVETo examine the experience and practice patterns of residents performing bedside procedures.DESIGN AND PARTICIPANTSCross-sectional e-mail survey of 653 internal medicine (IM) residents at seven California teaching hospitals.MEASUREMENTSSurveys asked questions in three areas: (1) resident experience performing procedures: numbers of procedures performed and whether they received other (e.g., simulator) training; (2) resident comfort performing and supervising procedures; (3) resident reports of their current level of supervision doing procedures, experience with complications as well as perceptions of factors that may have contributed to complications.RESULTSThree hundred sixty-seven (56%) of the residents responded. Most PGY1 residents had performed fewer than five of any of the procedures, but most PGY-3 residents had performed at least ten by the end of their training. Resident comfort for each procedure increased with the number of procedures performed (p < 0.001). Although residents reported that peer supervision happened often, they also reported high rates of supervising a procedure before feeling comfortable with proper technique. The majority of residents (64%) reported at least one complication and did not feel supervision would have prevented complications, even though many reported complications represented technique- or preparation-related problems.CONCLUSIONSResidents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-009-1226-z) contains supplementary material, which is available to authorized users.

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“…2 Moreover,proceduralcomplicationsconfera17% excess mortality rate compared with control subjects matched by the Acute Physiology and Chronic Health Evaluation score. 3 Patients who develop procedural complications have a 7-day increase in the length of inpatient stay and incur $12 913 in excess costs. 3 Iatrogenic pneumothoraces resulting from thoracentesis increase morbidity, mortality, and length of hospi-talization.…”

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confidence: 99%

Pneumothorax Following Thoracentesis

Feller‐Kopman²,

et al. 2010

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Iatrogenic pneumothorax is a common complication of thoracentesis and frequently requires chest tube insertion. Real-time ultrasonography use is a modifiable factor that reduces the pneumothorax rate. Performance of thoracentesis for therapeutic purposes and in patients undergoing mechanical ventilation confers a higher likelihood of pneumothorax. Experienced operators may have lower pneumothorax rates. Patient safety may be improved by changes in clinical practice in accord with these findings.

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Impact of procedure-related complications on patient outcome on a general medicine service

Cited by 16 publications

References 13 publications

Emergency medicine procedural skills: what are residents missing?

Emergency medicine procedural skills: what are residents missing?

Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency

Pneumothorax Following Thoracentesis

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