Journal ArticleDOI
Impact of a bedside procedure service on general medicine inpatients: A firm-based trial
Brian P. Lucas,Joseph K. Asbury,Yue Wang,Kuenok Lee,Rudolf Kumapley,Benjamin,Shane Borkowsky,Abdo Asmar +7 more
Reads0
Chats0
TLDR
The availability of a procedure service may increase the overall demand for bedside procedures and further studies should refine the indications for and anticipated benefits from these commonly performed invasive procedures.Abstract:
BACKGROUND
Procedure services may improve the training of bedside procedures. However, little is known about how procedure services may affect the demand for and success of procedures performed on general medicine inpatients.
OBJECTIVE
Determine whether a procedure service affects the number and success of 4 bedside procedures (paracentesis, thoracentesis, lumbar puncture, and central venous catheterization) attempted on general medicine inpatients.
DESIGN
Prospective cohort study.
SETTING
Large public teaching hospital.
PATIENTS
Nineteen hundred and forty-one consecutive admissions to the general medicine service.
INTERVENTION
A bedside procedure service was offered to physicians from 1 of 3 firms for 4 weeks. This service then crossed over to physicians from the other 2 firms for another 4 weeks.
MEASUREMENTS
Data on all procedure attempts were collected daily from physicians. We examined whether the number of attempts and the proportion of successful attempts differed based on whether firms were offered the beside procedure service.
RESULTS
The number of procedure attempts was 48% higher in firms offered the service (90 versus 61 per 1000 admissions; RR 1.48, 95% CI 1.06–2.10; P = .030). More than 85% of the observed increase was a result of procedures with therapeutic indications. There were no differences between firms in the proportions of successful attempts or major complications.
CONCLUSIONS
The availability of a procedure service may increase the overall demand for bedside procedures. Further studies should refine the indications for and anticipated benefits from these commonly performed invasive procedures. Journal of Hospital Medicine 2007;2:143–149. © 2007 Society of Hospital Medicine.read more
Citations
More filters
Journal ArticleDOI
Long-term retention of central venous catheter insertion skills after simulation-based mastery learning.
TL;DR: Skills acquired from SBML were substantially retained during one year, so programs should use periodic testing and refresher training to ensure competence.
Journal ArticleDOI
Simulation training and its effect on long-term resident performance in central venous catheterization.
C. Christopher Smith,Grace Huang,Lori R. Newman,Peter Clardy,David Feller-Kopman,Michael Cho,Trustin Ennacheril,Richard M. Schwartzstein +7 more
TL;DR: A CVC insertion simulation course improves procedural skills, but these skills decline over time, and simulation conferred no long-term additional benefit over traditional methods of procedural teaching.
Journal ArticleDOI
Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches
Grace Huang,Jakob I. McSparron,Ethan M Balk,Jeremy B. Richards,C. Christopher Smith,Julia S. Whelan,Lori R. Newman,Gerald W. Smetana +7 more
TL;DR: Evidence is strongest for the use of simulation and competency-based paradigms in teaching procedures, and these approaches should be the mainstay of programmes that train physicians to perform procedures.
Journal ArticleDOI
Recommendations on the use of ultrasound guidance for adult lumbar puncture: A position statement of the society of hospital medicine
Nilam J. Soni,Ricardo Franco-Sadud,Ricardo Franco-Sadud,Ketino Kobaidze,Daniel Schnobrich,Gerard Salame,Joshua D. Lenchus,Venkat Kalidindi,Michael Mader,Elizabeth K. Haro,Ria Dancel,Joel Cho,Loretta Grikis,Brian P. Lucas,Brian P. Lucas,Nilam J. Soni,Jeff Bates,Nitin Puri,Ricardo Franco,Benji Matthews,Saaid Abdel-Ghani,Sophia Chu Rodgers,Martin G Perez,Kreegan Reierson,Anjali Bhagra,P. Trevor,Josh Lenchus,David M. Tierney,Trevor Jensen,Robert Arntfield,Michael Blaivas,Richard Hoppmann,Paul H. Mayo,Vicki E. Noble,Aliaksei Pustavoitau,Kirk T. Spencer,Vivek S. Tayal,Mahmoud El Barbary,Daniel J. Brotman,Satyen Nichani,Susan Hunt,Nick Marzano +41 more
TL;DR: It is recommended that dedicated training sessions, including didactics, supervised practice on patients, and simulation-based practice, should be used to teach novices how to perform ultrasound-guided paracentesis to improve the success rates of the overall procedure.
Journal ArticleDOI
Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency
TL;DR: Although residents reported that peer supervision happened often, they also reported high rates of supervising a procedure before feeling comfortable with proper technique, and a need to examine best practices for procedural supervision of trainees.
References
More filters
Journal ArticleDOI
The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II
Lucian L. Leape,Troyen A. Brennan,Nan M. Laird,Ann G. Lawthers,A R Localio,B A Barnes,Liesi E. Hebert,Joseph P. Newhouse,Paul C. Weiler,Howard H. Hiatt +9 more
TL;DR: The high proportion that are due to management errors suggests that many others are potentially preventable now, and reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.
Journal ArticleDOI
Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains.
TL;DR: This article proposes an alternative framework to account for individual differences in attained professional development, as well as many aspects of age-related decline, based on the assumption that acquisition of expert performance requires engagement in deliberate practice and that continued deliberate practice is necessary for maintenance of many types of professional performance.
Journal ArticleDOI
Does Increased Access to Primary Care Reduce Hospital Readmissions
TL;DR: For veterans discharged from Veterans Affairs hospitals, the primary care intervention studied increased rather than decreased the rate of rehospitalization, although patients in the intervention group were more satisfied with their care.
Journal ArticleDOI
Professional uncertainty and the problem of supplier-induced demand.
TL;DR: The evidence reviewed here supports the hypothesis that variations occur to a large extent because of differences among physicians in their evaluation of patients or in their belief in the value of the procedures for meeting patient needs.
Journal Article
Costs of medical injuries in Utah and Colorado
Eric J. Thomas,David M. Studdert,Joseph P. Newhouse,Brett I.W. Zbar,K M Howard,E J Williams,Troyen A. Brennan +6 more
TL;DR: The costs of adverse events were similar to the national costs of caring for people with HIV/AIDS, and totaled 4.8% of per capita health care expenditures in these states.