National Fluid Shifts: Fifteen-Year Trends in Paracentesis and Thoracentesis Procedures

Duszak, Richard; Chatterjee, Arindam; Schneider, Debra

doi:10.1016/j.jacr.2010.04.013

Cited by 66 publications

(50 citation statements)

References 33 publications

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“…However, one primary factor may be that nephrologists perform fewer actual THDC insertions in contemporary clinical practice because of the increasing referral of procedures to interventional radiology (IR) (26). Referrals to IR do little in equipping nephrologists to practice competently in a situation where emergent dialysis access is required or at sites where radiology support may not be readily available.…”

Section: Discussionmentioning

confidence: 99%

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

McQuillan

Clark

Zahirieh

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Concerns have been raised about nephrology fellows' skills in inserting temporary hemodialysis catheters. Less is known about temporary hemodialysis catheter insertion skills of attending nephrologists supervising these procedures. The aim of this study was to compare baseline temporary hemodialysis catheter insertion skills of attending nephrologists with the skills of nephrology fellows before and after a simulation-based mastery learning (SBML) intervention.Design, setting, participants, & measurements This pre-post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. Fellows subsequently completed an SBML intervention, including deliberate practice with the central venous catheter simulator. Fellows were expected to meet or exceed a minimum passing score at post-test. Fellows who did not meet the minimum passing score completed additional deliberate practice. Attending nephrologist and fellow baseline performance on the temporary hemodialysis catheter skills assessment was compared. Fellows' pre-and post-test temporary hemodialysis catheter insertion performance was compared to assess the effectiveness of SBML. The skills assessment was scored using a previously published 28-item checklist. The minimum passing score was set at 79% of checklist items correct.Results In total, 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% items correct; SD=21.4%; P=0.55). Only two of 19 attending nephrologists (11%) met the minimum passing score at baseline. After SBML, fellows' mean post-test score improved to 91.3% (SD=6.9%; P,0.001). Median time between pre-and post-test was 24 hours.Conclusions Attending nephrologists' baseline temporary hemodialysis catheter insertion skills were highly variable and similar to nephrology fellows' skills, with only a small minority able to competently insert a temporary hemodialysis catheter. SBML was extremely effective for training fellows and should be considered for attending nephrologists who supervise temporary hemodialysis catheter insertions.

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Section: Discussionmentioning

confidence: 99%

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

McQuillan

Clark

Zahirieh

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…On a national scale, selecting a location for this procedure has a large financial impact as 150,000 paracentesis procedures were performed on Medicare recipients in 2008 alone. 8 Based on these findings, we expanded paracentesis SBML in 2013 to also include general surgery residents and are studying the impact on IR referral for surgical patients.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 A recent study of Medicare feefor-service beneficiaries showed that paracentesis procedures performed by radiologists increased by 964% from 1993 to 2008. 8 This shift has a large effect because the number of paracentesis procedures also increased by 133% during the same period. 8 In earlier work, we studied patient outcomes after paracentesis procedures performed either by IR or by simulation-trained internal medicine residents at the bedside.…”

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confidence: 99%

“…8 This shift has a large effect because the number of paracentesis procedures also increased by 133% during the same period. 8 In earlier work, we studied patient outcomes after paracentesis procedures performed either by IR or by simulation-trained internal medicine residents at the bedside. We found that 59% of the paracentesis procedures performed on patients admitted to an inpatient hepatology service at our institution were performed at the bedside and 41% of the procedures were referred to IR.…”

mentioning

confidence: 99%

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Cost Savings of Performing Paracentesis Procedures at the Bedside After Simulation-based Education

Barsuk¹,

Cohen

Feinglass

et al. 2014

Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare

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“…In the same study, the authors revealed dramatic increases in paid Medicare claims by NPs and PAs for paracenteses, thoracenteses, fine-needle aspirations, abdominal biopsies, thoracic biopsies, and superficial lymph node biopsies. A complementary analysis from 1993 to 2008 showed that paracenteses performed by PAs increased >1,000-fold and that thoracenteses performed by PAs increased >50-fold [23].…”

Section: Procedural Trendsmentioning

confidence: 99%

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Operational and Educational Implications

Hawkins¹,

Bowen²,

Gilliland³

et al. 2015

Journal of the American College of Radiology

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National Fluid Shifts: Fifteen-Year Trends in Paracentesis and Thoracentesis Procedures

Cited by 66 publications

References 33 publications

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

Cost Savings of Performing Paracentesis Procedures at the Bedside After Simulation-based Education

The Impact of Nonphysician Providers on Diagnostic and Interventional Radiology Practices: Operational and Educational Implications

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