A Medical Invasive Procedure Service and Resident Procedure Training Elective

Meeting: Hospital Medicine 2012, April 1-4, San Diego, Calif.

Abstract number: 97727

Background:

Experience in invasive bedside procedures is increasingly difficult to acquire for both resident and attending physicians. Inconsistent training, work hours restrictions, decreasing emphasis on procedural training, and lack of confidence can lead to a vicious cycle of decreasing experience in procedures. We established a medical inpatient procedure service (MIPS) consisting of an attending and resident physician, combined with a standardized didactic and simulator–based training program, to address these deficiencies in training and experience.

Purpose:

(1) To establish a MIPS available to all primary inpatient services at a large urban teaching hospital. (2) To provide a standardized multimedia, didactic and simulator–based training program in bedside invasive procedures.

Description:

Over a three–month period, we established a MIPS at a large urban teaching hospital. This consisted of a an attending hospitalist identified as being proficient in invasive procedures and a resident physician. Beforehand, hospitalists received education in procedural training and simulator training. Residents rotated through the service in two–week blocks, while hospitalists rotated through the service in one week blocks. Core invasive procedures covered by the MIPS included thoracentesis, paracentesis, lumbar puncture, and central venous catheter placement. The MIPS was available weekdays during daytime hours to help any primary inpatient service by performing necessary bedside invasive procedures. During each two–week block, each resident underwent a training session which consisted of standardized multimedia, didactic, and simulator based training. In addition to the Medicine residents on the elective, training sessions were also offered to residents and attendings in other subspecialties. The effectiveness of training was assessed through an assessment of (1) knowledge by a standardized and validated questionnaire and (2) demonstrated skill by a standardized and validated objective assessment.

Conclusions:

The MIPS resulted in a dramatic increase in the number of invasive procedures performed by an academic hospitalist service at a large urban hospital, as determined by billing data. Concurrently, the incidence of central line associated bloodstream infections (CLABSI) dropped dramatically. Increased procedural experience for both the attending hospitalists and resident physicians rotating through the MIPS was achieved. In addition, a training program was instituted successfully for both residents and attendings in Internal Medicine and other subspecialities.

Table 1Non–ICU Central Line Associated Bloodstream Infections

Year–Quarter # of CLABSI CLABSI/1000 line–days
2010–Q1 23 4.98
2010–Q2 14 2.25
2010–Q3 13 2.85
2010–Q4 17 4.06
2011–Q1 10 2.07
2011–Q2 11 2.47
Pilot Program instituted 2011–Q1 (Jan–Mar).

Table 2Procedural Experience Before and During MIPS

Procedure Before MIPS (12 wks) During MIPS (12 wks)
Paracentesis 13 62
Thoracentesis 0 11
Central Line 2 5
LP 4 23
Other 0 3
Charges $14,346 $74,377
Only procedures done on weekdays during daytime hours were included.

To cite this abstract:

Popa A, DeKorte M, Chang W. A Medical Invasive Procedure Service and Resident Procedure Training Elective. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97727. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/a-medical-invasive-procedure-service-and-resident-procedure-training-elective/. Accessed November 18, 2019.

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