Background:
Academic medical procedure services (MPS) arise from the continued need for procedural training in the setting of decreasing procedural opportunities, increasing safety awareness, and increasing demands on inpatient resident time. Prior research has shown that MPS can improve resident confidence, subjective patient and resident experience, and resident supervision. Little is known about the procedural volume, success, efficiency and safety of these services.
Purpose:
We developed an intern-based MPS in a tertiary care academic hospital with a goal of providing high volume, high quality, efficient and safe procedural training to early trainees in a large internal medicine residency program.
Description:
Our MPS was implemented in 2008 and has operated continuously on a Monday-Friday schedule. The service consists of a procedural hospitalist attending and up to two interns during a mandatory two-week rotation. These hospitalists provide standardized procedural teaching to all interns through lecture, video and simulation mediums. All adult inpatient services can consult our MPS for paracentesis, thoracentesis, lumbar punctures, and knee arthrocentesis. Interns log all requests in a secure database. The team reviews each request for appropriateness of indication, safety, and urgency. A standardized procedure template guides procedural best practices (e.g. timeouts and consent), and the team performs all procedures with ultrasound marking or guidance. Interns perform procedures whenever possible, and all procedures are done under the direct attending supervision. Appropriate and judicious ordering of diagnostic tests is discussed at the end of each procedure.
Review of data from Nov 2008 through June 2014 showed that 324 interns have rotated through the UCSF MPS. The service has attempted 3660 procedures referred by 25 different clinical services. Interns performed 91% of these procedures, with a median of 10 (IQR 12-7) procedures per intern. 93% of attempted procedures were successful. 88% of procedures were done on the day of request, and 99% were done by the day after request. Major complications (defined as death, major bleeding, or any adverse event resulting in hemodynamic instability, respiratory failure, or disability) occurred in 0.25% of procedures.
Conclusions:
Our results describe a sustained, high volume, successful, efficient and safe implementation of an intern-based hospitalist-supervised MPS at an academic tertiary care hospital. These data provide evidence that our service model is a safe, efficient and effective method of both training and performing high quality inpatient medical procedures.