Potential impact of a bedside procedure service on training procedurally competent hospitalists in a community-based residency program

Montuno, Anthony; Hunt, Bijou R.; Lee, May M.

doi:10.3402/jchimp.v6.31054

Cited by 10 publications

(25 citation statements)

References 16 publications

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“…Creation of an MPS places the responsibility of core bedside procedures in the hands of a select group of proceduralists. This strategy streamlines training and assessment of individual procedural competency to meet standards set by SHM 36,46 and improves educational outcomes 47‐49 . MPS could improve clinical outcomes, 12,42,50‐52 including length of stay and cost, while maintaining patient satisfaction, 41 as well as recoup lost revenue from referrals by increasing the volume of procedures done by generalists, 40,49 although no robust data supporting the latter point exists.…”

Section: Discussionmentioning

confidence: 99%

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

Cool¹,

Huang²

2021

Journal of Hospital Medicine

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BACKGROUND: As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience. METHODS: We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures. RESULTS: Our synthesis of the literature characterizes contributors to hospitalists’ procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists. CONCLUSION: We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.

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Section: Discussionmentioning

confidence: 99%

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

Cool¹,

Huang²

2021

Journal of Hospital Medicine

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“…Several studies described outcomes of attending-led bedside procedure services, but to our knowledge there are no previous reports describing a residentdriven bedside procedure service without routine attending involvement. [6][7][8][9] The RPC increased the total number of procedures available to residents. The availability of ultrasound-guided PIVs resulted in a perceived decrease in the need for more invasive central line insertion with its associated complications.…”

Section: Discussionmentioning

confidence: 99%

“…4 Resident opportunities to perform procedures have diminished, as a number of procedures formerly performed by internists are now being performed by interventional radiologists. 5 In response, some institutions have created attendingrun procedure teams [6][7][8][9] that have been shown to increase the volume of procedures performed, residents' comfort, and self-reported knowledge and competence. 8,9 Significant barriers to starting a procedure service include the financial investment required and the lack of proceduralists to staff the service.…”

Section: Introductionmentioning

confidence: 99%

The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

Gorgone

McNichols

Lang

et al. 2018

Journal of Graduate Medical Education

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Background Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician-led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results Compared with preimplementation procedure logs, there were substantial increases postimplementation in residentperformed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

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“…For example, in a study by Grover et al, residents in their nal year of training reported performing only 3 thoracenteses throughout the course of their residency 2 . The presence of a facultystaffed procedure service available to offer supervision of resident procedures has been shown to increase the number of procedures performed and signi cantly increase rates of certi cation 10 . In a study by Lucas et al, the mean number of procedure attempts in resident medical services with access to a procedure team was 48% higher than in those without such access 11 .…”

Section: Introductionmentioning

confidence: 99%

Advancing Internal Medicine Training: Experience of a Bedside Procedure Service as a Resident Elective

et al. 2021

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Background: In 2007, the American Board of Internal Medicine eliminated numeric procedure requirements for licensing. The level of exposure to procedures during residency, and subsequent competence of graduating residents, is variable. In 2015, our institution developed a bedside procedure service (BPS) with the intent to teach ultrasound guidance and procedural training to internal medicine residents with direct supervision of technique by Hospital Medicine faculty to optimize learning, increase con dence, and improve patient safety.Objective: In this study, we review the number and complication rates of resident procedures on a dedicated internal medicine bedside procedure service (BPS) as a resident elective.Methods: In this retrospective, observational, single-center study, we reviewed internally collected data from BPS procedures performed from 2015-2019. The BPS offers a variety of procedures done with ultrasound guidance at an adult tertiary care referral center. BPS services are available to all inpatient hospital services. A rotation with the BPS was offered as a stand-alone resident elective for the rst time in 2015.Results: 69 residents performed a total of 2700 ultrasound-guided/assisted procedures and 146 diagnostic ultrasound scans from 2015-2019. Residents performed an average of 40 procedures during their elective month. There were 5 resident performed procedural complications with an overall complication rate of 0.19%. Conclusions: Our BPS increased procedural opportunities for residents and allowed for real-time feedback by an experienced faculty member in a one-on-one setting. A dedicated rotation allows the time to focus on becoming pro cient in invasive procedures with expert supervision.

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Potential impact of a bedside procedure service on training procedurally competent hospitalists in a community-based residency program

Cited by 10 publications

References 16 publications

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

Procedural Competency Among Hospitalists: A Literature Review and Future Considerations

The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

Advancing Internal Medicine Training: Experience of a Bedside Procedure Service as a Resident Elective

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