Background: With increasing subspecialization in the field of Internal Medicine, the role of the hospitalist has metamorphosed, and the expectation for certification in specialized procedures, such as paracentesis, has diminished. Many hospitalist groups have traditionally relied on procedure services to manage specialized procedures. As a result, the majority of hospitalist faculty, and to a greater degree house staff, are uncertified to perform these procedures which were previously squarely in their scope of practice. This gap in certification poses challenges for procedural safety and operational efficiency.
Purpose: To leverage secure chat technology to connect paracentesis-certified faculty and residents with new learners eager to gain certification. The initiative aims to enhance procedural safety, streamline operations, and ensure compliance with guidelines while proliferating procedural competency within the Hospital Medicine service.
Description: The project involved several key components: 1. Secure Chat Integration: A secure chat platform was implemented to facilitate real-time communication between certified faculty, residents, and new learners. This platform enabled quick access to expertise and support during procedures. 2. Certification Program Embedded in New Innovations Logging: A structured certification program was established, focusing on training and certifying residents in paracentesis. This program aimed to increase the number of certified practitioners and ensure consistent procedural standards. 3. Operational Streamlining: The secure chat system helped streamline procedural operations by ensuring that certified personnel were available to supervise and assist with procedures, reducing delays and enhancing patient safety. 4. Rigorous Training: A partnership between the residency program and the Department of Critical Care Medicine has yielded proprietary online modules which provide comprehensive insight into the procedure, and a high bar is set for the minimum requirement of procedures successfully completed before becoming independently certified. 5. Compliance and Guidelines: Clear guidelines and protocols were developed to ensure compliance with medical standards and billing procedures, emphasizing the importance of consent and proper documentation.
Conclusions: The structured approach of this initiative, facilitating access to both training and supervision, has enhanced faculty and resident competency and confidence with advanced procedures, in addition to increasing the number of certified proceduralists. The integration of secure chat technology and the establishment of a certification program have significantly improved procedural safety and efficiency, as well as optimized patient care by decreasing previously experienced delays. Preliminary data shows an average of 3 procedure requests per week, with an average response time by a supervisor within five minutes, and the procedure being attempted later that same day. By utilizing our program’s own vetted and expert-designed online self-paced learning module, as well as connecting certified proceduralists with new learners at various levels of training, the initiative has fostered a collaborative, energetic learning environment. Finally, clear guidelines, protocols, and compliance measures have supported the initiative’s long-term success and sustainability.