Background: Bone marrow biopsies (BMB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. BMB are a straightforward procedure with a generally low complication rate. In lieu of using specialists (eg, oncologists) or computed tomography (CT) guidance with radiology, procedure-focused hospitalists can provide an excellent option for doing inpatient BMB efficiently with good success rates and low complications. We are presenting five years of experience with a bedside hospitalist team performing BMB in our institution.
Methods: The Internal Medicine Bedside Procedure Service (BPS) at our institution began to perform bone marrow biopsies at the patient bedside in 2016. From 2015-2016, faculty members on the BPS team were trained by the oncology department to do a standard BMB with core and aspirate using a Teleflex Oncontrol Power Driver drill via a posterior iliac crest approach. We evaluated internally collected data from the procedures performed by the BPS from 2016-2020. The data was logged by the BPS attendings and reviewed twice monthly by the service director. Data was stored on a protected server. The BPS offers a variety of procedures at an adult tertiary care referral center for hospitalized patients with a large oncology program. In addition to the inpatient oncology services, the BPS performed BMB on patients at the request of the inpatient hematology consult service team.
Results: The BPS performed 25 BMB from 2016-2017, 122 from 2017-2018, 113 from 2018-2019, 85 from 2019-2020, and 88 from 2020-21 for a total of 433 procedures. Sixty-two patients had a platelet count that was < 20,000/µL. Seventeen patients were on therapeutic anticoagulation or had an international normalized ratio (INR) ≥2 at the time of their BMB. There was one complication over this time period which was a retroperitoneal hematoma. Thirty-seven (8.5%) of the attempted biopsies were unsuccessful and required referral for CT guidance. The most common reasons for unsuccessful biopsies were morbid obesity and inability of the patient to tolerate the procedure without sedation, which our service is not credentialed to provide. Trainees assisted in 64 (14.8%) of the procedures with no associated complications.
Conclusions: In 2016, the BPS began a novel partnership with the oncology service at our large tertiary care center. Internal Medicine hospitalists were trained to perform BMB at bedside with excellent rates of success and a very low number of complications despite the often high-risk coagulation parameters of the patients requiring biopsy. This arrangement allowed for more efficiency in performing the biopsies and better use of resources. Additionally, internal medicine residents were able to get exposure to a procedure that was otherwise not easily accessible to them. We hope that this arrangement can provide a model for other institutions and expand the procedural abilities of hospitalists.