Background: Procedural complications are a common source of adverse events in hospitalized patients(1, 2). In academic centers, bedside procedures have traditionally been performed by trainees, often without experienced proceduralist supervision, or referred to interventional radiology or consultant services, often with an associated delay in procedure performance. Many trainees report discomfort with their skill in performing [...]

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: 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: 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: 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: Testing of ascitic fluid is recommended in all patients admitted to the hospital and delay in paracentesis has been shown to increase in-hospital mortality. Academic hospitalists in collaboration with internal medicine residency programs are establishing medicine procedure services to address concerns about resident training in procedures and patient safety. Our aim in this study [...]

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 [...]

Background: Internal medicine and hospital medicine providers are under pressure to move patients quickly through the hospital and decrease length of stay. Providers spending 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 [...]