Background: Patients with cirrhosis complicated by ascites are often admitted to the hospital and require abdominal paracentesis for diagnostic evaluation and symptom relief. When large volumes are removed there is a risk for acute kidney injury (AKI) which can contribute to morbidity and mortality. There are no clear guidelines for what constitutes a safe volume [...]

Background: Hospitalized patients may require central venous access devices (CVADs) for inadequate intravenous (IV) access. CVADs have known complications, including peri-procedural trauma and central line associated bloodstream infections (CLABSI). CLABSI is of concern for patients and hospital systems, as it is largely preventable and used as a quality measure. A CVAD alternative is a short [...]

Background: Medicine procedure services (MPS) increasingly perform bedside procedures such as lumbar puncture (LP). 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 [...]

Background: Hospitalist-run Medical Procedure Services (MPS) have been shown to decrease time-to-procedure, overall length of stay, and interventional subspecialty consults for bedside procedures while increasing revenue for hospitalist groups [1,2,3,4]. However, significant challenges remain in the deployment of a financially sustainable MPS, and there is interest in identifying and deploying strategies to improve sustainability. Two [...]