Background: Nearly half of incorrect procedures occur outside the operating room, and failure to conduct a robust time-out is a frequent root cause. Mannequin-based simulation (MBS) has been shown to improve self-confidence and performance of time-outs, but is expensive, time-consuming, and difficult to scale up effectively for large groups of medical learners. Screen-based simulation (SBS) [...]

Background: Lumbar puncture and paracentesis are core competencies in internal medicine, but residents frequently report discomfort performing these procedures unsupervised. Simulation-based training (SBT) has previously been shown to improve resident performance of lumbar punctures on patients, but outcomes after paracentesis SBT have only been assessed on simulators. We hypothesized that SBT would improve internal medicine [...]

Background: Tissue pathology plays an integral role in the diagnosis of various conditions, especially malignancy. Traditionally biopsy procedures, including core needle biopsy (CNB), have been performed by specialists under imaging guidance. They are traditionally done in special procedure rooms/suites–which come with an added cost of nursing staff, transportation and equipment. Meanwhile hospitalists are increasingly becoming [...]

Background: Small-bore pulmonary drains (PD) have been proven effective at replacing the previous large-bore chest tubes for resolution of pneumothorax (PTX), and management of complicated (CPEs) and recurrent pleural effusions (RPEs). The placement of these drains has traditionally been performed by Surgeons, Intensivists/Pulmonologists, and Interventional Radiologists. Our institution (large academic center) sought to determine whether [...]

Background: Ultrasound-guidance has become the standard for bedside procedures in the emergency and inpatient settings due to its perceived impact on first attempt success and complications. Prior literature on paracentesis notes a 10% rate of overall complications, 5% rate of technical problems, and a 1% rate of bleeding. However, existing cohorts often include outpatients or [...]

Background: Venous access is commonly required in hospitalized patients for the administration of intravenous fluids and medications and blood products. Peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) are required for the administration of vasopressors, chemotherapy, or total parenteral nutrition but often they are placed due to difficulty obtaining a peripheral venous catheter [...]

Background: Each year 45 million procedures are performed in the United States. For elective procedures, the preoperative evaluation is an opportunity to identify and manage risk factors that may contribute to post -operative morbidity and mortality. Increasingly thispre-operative visit has come under the purview of hospital medicine. While studies have demonstrated that pre-operative evaluations reduce [...]

Case Presentation: A 53 year old female originally underwent an ablation for atrial fibrillation with post procedure course pericardial effusion requiring drain placement for 3 days. Patient recovered from original effusion and was sent home with colchicine and aspirin. She presented to our care on day 28 after procedure, one week after recent hospitalization. Patient [...]

Case Presentation: A 43-year-old female patient with no medical history presented with multiple abdominal wall abscesses. She attended a cosmetic spa four months prior where she received weight loss injections known as “carboxy therapy” to her abdomen. Subsequently, she developed enlarging painful red lesions of varying sizes at the injection sites. She underwent incision and [...]