Background: The advent of internal medicine procedure services within academic medical centers has had a profoundly positive impact on patient care, patient safety, and resident training (1-4). In general, these teams focus on performing invasive bedside procedures, including paracenteses, lumbar punctures, central venous catheter placements, thoracenteses, and ultrasound-guided peripheral intravenous catheter placements. Recently, the procedure service at [...]

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 [...]

Background: Central venous catheters (CVC), including temporary dialysis catheters, are a relatively frequent procedure needed in the inpatient setting. Historically in our institution, CVC have been placed in the intensive care unit (ICU) by critical care staff or in the radiology suite by interventional radiology staff. The reasons for this placement preference have included the [...]

Background: Cirrhosis was the fifteenth leading cause of death in the United States in 2019, with ascites being the most common major complication leading to hospital admission. Patients with ascites have recurrent hospital admissions with disproportionate use of hospital resources. Large volume abdominal paracentesis can be done safely by trained providers and is associated with [...]

Background: Point-of-care ultrasound (POCUS) is a growing interest in pediatric hospital medicine, however few Pediatric Hospital Medicine (PHM) fellowships incorporate POCUS training formally into their curriculum. In addition to its ability to expedite care, POCUS can improve the ability of pediatric hospitalists to take care of patients in resource-limited settings or when specialists are not [...]

Background: Medical providers are often hesitant to perform bedside procedures in patients with an INR >2 or in patients who have received chemoprophylaxis or therapeutic anticoagulation, despite previously conducted studies suggesting cirrhotic patients with elevated INRs are not at higher risk for complications from a paracentesis or thoracentesis (1)(2). The Hospital Medicine Advanced Practice Provider [...]

Background: Lumbar punctures are an important diagnostic and therapeutic tool for internists. While rates of major complications are low, success rates in the literature are widely variable and dependent on patient body habitus, patient positioning, operator experience, and use of ultrasound guidance.1 Many trainees report discomfort with their skill in performing and supervising bedside procedures, [...]