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: 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: The latest guidelines on parapneumonic effusion (PPE) management1 recommend immediate evaluation of PPE with ultrasound. Recognizing that bedside procedure services (BPSs) staffed with procedural hospitalists (proceduralists) are becoming the first point of ultrasound contact for many patients admitted with PPE our study sought to demonstrate that proceduralists can reliably agree with radiologists (viewed as [...]

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: 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: Medical procedure services (MPS) are increasingly implemented in Hospital Medicine programs to promote resident learning, support provider workloads, and expedite performance of common bedside medical procedures, including thoracentesis, paracentesis, and lumbar puncture (LP) [. Prior work has demonstrated safety and positive educational experience with MPS but little data exists on the impact of MPS [...]

Background: Internal medicine and hospital medicine providers are under pressure to move patients quickly through the hospital and decrease length of stay. Providers spend most of their clinical time seeing patients, documenting or coordinating care and have minimal time to disrupt workflow to perform common bedside procedures such as paracentesis, lumbar punctures, central lines, arthrocentesis [...]

Background: Internal medicine and hospital medicine providers are under pressure to move patients quickly through the hospital and decrease length of stay. Providers spend most of their clinical time seeing patients, documenting or coordinating care and have minimal time to disrupt workflow to perform common bedside procedures such as paracentesis, lumbar punctures, central lines, arthrocentesis [...]

Background: Diagnosis of complications is important for patient care, diagnostic quality, and safety. Paracentesis is a common procedure among hospitalized patients. The use of ultrasound decreases complications and improves safety. We aimed to characterize the complication rate observed among paracenteses performed by a hospital medicine bedside procedures service (MPS) before and after a transition to [...]

Background: Many hospitalist programs have established a bedside procedure team to encourage timeliness of necessary bedside procedures, reduce diagnostic delays, and decrease length of stay. We assessed the impact of a bedside procedure team on the timeliness of the procedure and length of stay (LOS). Methods: A hospitalist-run On-call Procedure Team (OPT) was launched in [...]