Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by [...]

Background: Several institutions have implemented a medical procedure service (MPS) to improve timeliness of bedside procedures and standardize performance and training of procedures by internal medicine (IM) residents (1-2). A critical barrier to starting an MPS has been a lack of experienced proceduralists (3). In 2011, our IM residency program created an MPS led by [...]

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: Bone marrow biopsies (BMB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. BMB are a straightforward procedure with a generally low complication rate. In lieu of using specialists (eg, oncologists) or computed tomography (CT) guidance with radiology, procedure-focused hospitalists can provide an excellent option for doing [...]

Background: Central venous catheters (CVC), including temporary dialysis catheters, are a relatively frequent procedure needed in the inpatient setting. Historically in our institution, CVC have been placed in the intensive care unit (ICU) by critical care staff or in the radiology suite by interventional radiology staff. The reasons for this placement preference have included the [...]

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: The American Board of Internal Medicine expects all general internists to be competent, at least “with regard to their knowledge and understanding,” in bedside paracentesis, thoracentesis, central venous catheterization, and lumbar puncture, among other less invasive procedures.  Unfortunately, increasing patient loads with a focus on efficiency caused a shift away from our hospitalist group [...]

Background: Central venous lines (CVL), including temporary dialysis catheters, are often required in the inpatient setting. While CVLs are frequently placed in radiology suites or intensive care units (ICU), many institutions allow placement on medical-surgical wards by Hospitalist Bedside Procedure Services (BPS). The BPS at our institution began to perform CVL placement at the patient [...]

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 [...]