Background: Internal medicine residency contains procedural training, including guidance in paracentesis, thoracentesis, lumbar puncture, arthrocentesis, and central line placement. As a result, most hospitalists are able to perform these bedside procedures. However, national trends confirm that these procedures are increasingly referred to interventional radiology, and these referrals are associated with higher direct hospital costs.1 Enhancing [...]

Background: The American Board of Internal Medicine suggests residents participate in a minimum of five abdominal paracentesis (AP), central venous catheter (CVC) placements, and lumbar punctures to ensure “adequate knowledge and understanding” of procedures performed by practicing internists. Competency in these procedures is poorly defined and difficult to assess. To address the need for well-supervised, [...]

Background: Endovascular cardiac valve replacement continues to increase in popularity as it becomes more of a standard of care for valve replacements. As the number of ECVR grows each year, complications associated with these procedures may elevate the cost and limit the viability of these procedures in healthcare systems. Hospitalists need to be aware of [...]

Background: Paracenteses are performed frequently at bedside by hospitalists, intensivists, gastroenterologists and emergency medicine providers. They are considered a core procedure that historically have been performed “blind” with only the use of percussion to determine the presence of fluid. With the rise of ultrasound based procedures the majority of paracenteses are now performed with ultrasound [...]

Background: Procedures are often an integral component of a patient’s care plan. Delays in procedures may lead to increased length of stay and decreased quality of care. For instance, prompt paracenteses in hospitalized patients with ascites is associated with a 24% decreased mortality in one study. At our institution, hospital throughput is essential given a [...]

Case Presentation: The patient is a 61-year-old male theatre director who presented with chronic diarrhea associated with a 50-pound weight loss, fatigue, and weakness. His past surgical history was notable of a Whipple’s procedure done 10 years ago for a symptomatic duodenal mass causing nausea and vomiting, later found to be benign in nature. Patient [...]