Background: Many hospitalist programs have established a bedside procedure team to encourage timeliness of necessary bedside procedures, reduce diagnostic delays, and decrease length of stay. We assessed the impact of a bedside procedure team on the timeliness of the procedure and length of stay (LOS).
Methods: A hospitalist-run On-call Procedure Team (OPT) was launched in April 2023, at a large, single, urban-setting, tertiary care hospital. The OPT hospitalist typically had a full patient panel on a traditional Medicine Service and was available to perform bedside procedures at the request of any of the Medicine teams. In this analysis, we reviewed all patients who underwent lumbar puncture (LP) from April 2022 through April 2024, one year before and after the launch of the OPT. We queried all cerebrospinal fluid samples in the electronic medical record while patients were under hospitalists’ care. The procedure team maintained a HIPAA compliant procedure database of all LPs attempted, which was matched to the query result from April 2023 to April 2024. A total of seven cases were excluded because the initial LP was not successful, and a second attempt was deferred or not successful. We compared the median length of stay (LOS) and mean time from request to procedure (R2P) before and after the launch of the procedure team.Mann-Whitney U and t-tests were implemented as appropriate. All statistical analyses were performed using Excel.
Results: 81 cases were completed during the pre-OPT period and 84 cases were completed during the OPT period. Median LOS were 19.0 and 21 days, respectively (p=0.16). Of cases completed during the OPT period, 63 cases were successful (75%) on the initial attempt. Median LOS for successful vs. unsuccessful LPs were 21.0 vs. 23.0 days (p=0.95).The mean R2P between pre-OPT and during OPT periods were 2.8 and 2.1 days, respectively (t=1.38, p=0.17). The mean R2P was significantly lower for successful compared to unsuccessful LPs (1.5 vs. 4.1 days, respectively; t=5.57, p< 0.05).Before the launch of the hospitalist-run procedure team, LPs for patients on hospitalist services were performed by neurology (27.2%), neuroradiology (23.5%), ED (16.0%), medicine primary team (13.6%), surgical services (9.9%), oncology (7.5%), and critical care (2.5%). During the OPT period, most LP requests by hospitalist services were completed by the procedure team (73.6%). The unsuccessful attempts by the procedure team were eventually completed by neuroradiology (14.9%), with the remaining completed by neurology (2.3%), and critical care (2.3%).
Conclusions: We found a trend for a decreased R2P after the launch of the OPT compared to the pre-OPT period. The mean R2P was significantly shorter for patients with successful LPs compared to those with unsuccessful LPs, which may be due to more complex patients requiring additional time for optimization, such as managing agitation, or coordinating bedside ventilator management. Our findings suggest that a procedure team may be able to reduce diagnostic delay.