Background: Medical procedure services (MPS) are increasingly implemented in Hospital Medicine programs to promote resident learning, support provider workloads, and expedite performance of common bedside medical procedures, including thoracentesis, paracentesis, and lumbar puncture (LP) [. Prior work has demonstrated safety and positive educational experience with MPS but little data exists on the impact of MPS on operational efficiency, such as accessibility of procedures on weekends and hospital length of stay (LoS). We examined whether procedure performance by MPS was associated with shorter LoS.
Methods: We conducted a retrospective cohort study of patients hospitalized at a 1,010-bed tertiary referral academic medical center who underwent bedside medical procedures between July 2021, when the hospital-medicine run MPS was launched, and July 2023. MPS was available during business hours all days of the week. We collected demographic and clinical data, including Charlson Comorbidity Index, from the electronic medical record of patients who underwent thoracentesis, paracentesis, or LP. Primary outcomes were post-procedure LoS and overall hospital LoS. Student t-test and chi-square test were used to compare characteristics of patients whose procedures were performed by MPS vs non-MPS providers. Logistic regression and negative binomial regression analyses were used to evaluate associations between primary outcomes and provider type (MPS vs non-MPS) while accounting for demographic factors, body mass index and comorbidity score.
Results: Of 4952 procedures in this analysis, MPS performed 1499 (30%), including 371 (24.7%) that occurred on weekends. MPS performed 456 (30%) thoracenteses, 859 (57%) paracenteses, and 184 (12.3%) LPs. Compared to non-MPS providers, MPS providers performed procedures on patients who were older (median, 62 vs 58 years, p< 0.001) and had higher comorbidity scores (median,12 vs 8, p< 0.001) (Table 1). Procedures performed by MPS providers were more likely to occur on weekends (Odds Ratio [OR], 1.99; 95% Confidence Interval [CI], 1.70 to 2.33) compared to those by non-MPS providers. Patients had a shorter post-procedure LoS (Incident Rate Ratio [IRR], 0.81; 95%CI, 0.76 to 0.87) and shorter overall LoS (IRR, 0.93; 95%CI, 0.87 to 0.99) when the performing provider was MPS vs. non-MPS.
Conclusions: In this single-site study, a hospitalist-run medical procedure service available all days of the week is associated with shorter post-procedure and overall hospital lengths of stay. Further studies are necessary to assess related clinical outcomes and net economic value of a medical procedure service program.
