A specialized team to perform nonemergent invasive procedures is desired within hospitals Hospitalists are the ideal candidates to meet such demands. Because of the recent de‐emphasis by ABIM on proving manual proficiency of bedside procedures as a requisite for certification, there has been a steady decline in the number of physicians trained. These procedures (lumbar punctures, abdominal paracenteses, and midline IVs) are now being deferred to “specialty” services, which adds to utilization and leads to increased length and cost of hospitalization. The advancements in portable ultrasonography and simulation training have substantially increased the timeliness and decreased the complication rates for invasive procedures. The development of a resident‐directed invasive procedure team (IPT) was aimed at training hospitalists and residents to perform procedures and decreasing complications and costs.
Each member of the IPT received a standardized didactic session regarding the indications, contraindications, recognition, and management of complications, pain management, and sterile techniques of each procedure. The didactics were followed by hands‐on training using ultrasonography and simulation on a Blue Phantom Model. Competency was measured using pre‐ and posttests. Each member was required to receive a passing score > 95%. Similar to any other consulting services at our institution, computerized physician order entry/electronic medical records (EMR) were utilized to keep track of all consultations placed and their complication rates. Once deemed medically necessary, each requested procedure was performed within 24 hours (Monday through Friday) by a member of the IPT and supervised by an experienced hospitalist. Clinician perception of the meaningful use of the IPT was assessed using an online postimplementation survey
The resident‐directed invasive procedure team reduced cost and improved overall satisfaction from the consulting clinicians. Three hundred procedures were performed, with zero complications at 24 hours. Utilization of specialty services, such as interventional radiology, were reduced as well as the risk of “nonprocedural” complications. Eighty‐five percent of residents consulted the IPT for a procedure. Ninety‐four percent of residents felt that an internal medicine–based IPT improved the quality of care delivered to patients, and 91% believed procedures were difficult to obtain when the IPT was not available. Ninety‐three percent of residents felt the IPT would be a positive addition to their residency training.
A resident‐directed invasive procedure team (IPT) is a viable and valuable alternative for hospitals faced with changing ABIM guidelines regarding in‐hospital procedures. Portable bedside ultrasonography is becoming an indispensable tool for improved patient care regarding invasive procedures. Bedside procedures improve patient satisfaction and reduce utilization and costs. Complication rates of 0% are achievable and maintainable with a dedicated IPT.
To cite this abstract:Gong J, Ouchi K, Zeitoun N, Kurian L, Ahmed S, Hertz C, Barnett B. The Invasive Procedure Team: Improving Patient Care and Resident Education. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 88. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/the-invasive-procedure-team-improving-patient-care-and-resident-education/. Accessed April 21, 2019.