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The Impact of a Medical Procedure Service on Patient Safety, Procedure Quality and Resident Training Opportunities

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A Capsule Commentary to this article was published on 24 December 2013

ABSTRACT

BACKGROUND

At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities.

OBJECTIVE

To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities.

DESIGN

Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service.

PARTICIPANTS

Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011.

MAIN MEASURES

The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of “best practice” safety process measures.

KEY RESULTS

We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p = 0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p = 0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p = 0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p = 0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p = 0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p < 0.0001).

CONCLUSIONS

Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.

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REFERENCES

  1. Hicks CM, Gonzalez R, Morton MT, Gibbons RV, Wigton RS, Anderson RJ. Procedural experience and comfort level in internal medicine trainees. J Gen Intern Med. 2000;15:716–722.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Mourad M, Kohlwes J, Maselli J, Auerbach AD. Supervising the supervisors—procedural training and supervision in internal medicine residency. J Gen Intern Med. 2010;25:351–356.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370–376.

    Article  CAS  PubMed  Google Scholar 

  4. Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377–384.

    Article  CAS  PubMed  Google Scholar 

  5. Lenhard A, Moallem M, Marrie RA, Becker J, Garland A. An intervention to improve procedure education for internal medicine residents. J Gen Intern Med. 2008;23:288–293.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Lucas BP, Asbury JK, Wang Y, Lee K, Kumapley R, Mba B, et al. Impact of a bedside procedure service on general medicine inpatients: a firm-based trial. J Hosp Med. 2007;2:143–149.

    Article  PubMed  Google Scholar 

  7. Mourad M, Auerbach AD, Maselli J, Sliwka D. Patient satisfaction with a hospitalist procedure service: is bedside procedure teaching reassuring to patients? J Hosp Med. 2011;6:219–224.

    Article  PubMed  Google Scholar 

  8. Smith CC, Gordon CE, Feller-Kopman D, Huang GC, Weingart SN, Davis RB, et al. Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med. 2004;19:510–513.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Huang GC, Smith CC, Gordon CE, Feller-Kopman DJ, Davis RB, Phillips RS, et al. Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med. 2006;119:71e17–71e24.

    Article  Google Scholar 

  10. Mourad M, Ranji S, Sliwka D. A randomized controlled trial of the impact of a teaching procedure service on the training of internal medicine residents. J Grad Med Educ. 2012;4:170–175.

    Article  PubMed Central  PubMed  Google Scholar 

  11. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39:S1–S34.

    Article  PubMed  Google Scholar 

  12. Graham AS, Ozment C, Tegtmeyer K, Lai S, Braner DA. Videos in clinical medicine. Central venous catheterization. N Engl J Med. 2007;356:e21.

    Article  PubMed  Google Scholar 

  13. Havelock T, Teoh R, Laws D, Gleeson F. Pleural procedures and thoracic ultrasound: British thoracic society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):ii61–ii76.

    Article  PubMed  Google Scholar 

  14. Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, et al. Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008;29(Suppl 1):S22–S30.

    Article  PubMed  Google Scholar 

  15. Miranda JA, Trick WE, Evans AT, Charles-Damte M, Reilly BM, Clarke P. Firm-based trial to improve central venous catheter insertion practices. J Hosp Med. 2007;2:135–142.

    Article  PubMed  Google Scholar 

  16. Accreditation Council for Graduate Medical Education. http://www.acgme.org/acgmeweb/Portals/0/PFAssets/2013-PR-FAQ-PIF/140_internal_medicine_07012013.pdf. Accessed September 17 2013.

  17. American Board of Internal Medicine. http://www.abim.org/certification/policies/imss/im.aspx. Accessed September 17 2013.

  18. Wickstrom GC, Kolar MM, Keyserling TC, Kelley DK, Xie SX, Bognar BA, et al. Confidence of graduating internal medicine residents to perform ambulatory procedures. J Gen Intern Med. 2000;15:361–365.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Wigton RS, Alguire P. The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians. Ann Intern Med. 2007;146:355–360.

    Article  PubMed  Google Scholar 

  20. Barsuk JH, McGaghie WC, Cohen ER, Balachandran JS, Wayne DB. Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit. J Hosp Med. 2009;4:397–403.

    Article  PubMed  Google Scholar 

  21. Barsuk JH, McGaghie WC, Cohen ER, O’Leary KJ, Wayne DB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit. Crit Care Med. 2009;37:2697–2701.

    Article  PubMed  Google Scholar 

  22. Lucas BP, Asbury JK, Franco-Sadud R. Training future hospitalists with simulators: a needed step toward accessible, expertly performed bedside procedures. J Hosp Med. 2009;4:395–396.

    Article  PubMed  Google Scholar 

  23. Wayne DB, Barsuk JH, O’Leary KJ, Fudala MJ, McGaghie WC. Mastery learning of thoracentesis skills by internal medicine residents using simulation technology and deliberate practice. J Hosp Med. 2008;3:48–54.

    Article  PubMed  Google Scholar 

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Acknowledgements

Research Funding

Dr. Wiener is supported by the National Cancer Institute [Grant K07 CA 138772] and the Department of Veterans Affairs.

Prior Presentations

American Thoracic Society International Conference, San Francisco, CA, May 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The views expressed herein are those of the authors and do not necessarily represent the policy or position of the Dept. of Veterans Affairs or the United States government.

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Authors and Affiliations

  1. The Pulmonary Center, Boston University School of Medicine, 72 E. Concord Street, R-304, Boston, MA, 02118, USA

    Melissa H. Tukey MD, MSc & Renda Soylemez Wiener MD, MPH

  2. Center for Healthcare Organization & Implementation Research, ENRM VA Hospital, Bedford, MA, USA

    Renda Soylemez Wiener MD, MPH

  3. The Dartmouth Institute for Health Policy & Clinical Practice, Hanover, NH, USA

    Renda Soylemez Wiener MD, MPH

Authors
  1. Melissa H. Tukey MD, MSc
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  2. Renda Soylemez Wiener MD, MPH
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Correspondence to Melissa H. Tukey MD, MSc.

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Tukey, M.H., Wiener, R.S. The Impact of a Medical Procedure Service on Patient Safety, Procedure Quality and Resident Training Opportunities. J GEN INTERN MED 29, 485–490 (2014). https://doi.org/10.1007/s11606-013-2709-5

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  • DOI: https://doi.org/10.1007/s11606-013-2709-5

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