Med-peds resident, Hillary Spangler, MD, and hospitalists, John Stephens, MD, Emily Sturkie, MD, and Ria Dancel, MD, published “Implementation of an academic hospital medicine procedure service: 5-year experience” in Hospital Practice.
Procedural complications are a common source of adverse events in hospitals, especially where bedside procedures are often performed by trainees. Medicine procedure services (MPS) have been established to improve procedural education, ensure patient safety and provide additional revenue for services that are typically referred. Prior descriptions of MPS have reported outcomes over one to two years. Researchers aimed to describe implementation and five-year outcomes of a hospitalist-run MPS.
The team identified all patients referred to MPS for a procedure over the five-year span between 2014-2018, and manually reviewed all charts for complications of paracentesis, thoracentesis, central venous catheterization, and lumbar punctures performed by the MPS in both inpatient and outpatient settings. Annual charges for these procedures were queried using Current Procedural Terminology (CPT) codes.
The team also identified 3,634 MPS procedures. Of these, ultrasound guidance was used in 3224 (88.7%) and trainees performed 2701 (74%). Complications identified included pneumothorax (3.7%, n=16) for thoracentesis, post-dural puncture headache (13.9%, n=100) and bleeding (0.1%, n=1) for lumbar puncture, ascites leak for diagnostic (1.6%, n=8) and large volume (3.7%, n=56) paracentesis, and bleeding (3.5%, n=16) for central venous catheter placement. Prior to initiation of the MPS, total annual procedural charges were $90,437. After MPS implementation, charges increased to a mean of $787,352 annually in the last 4 years of the study period.
The researchers concluded that implementation of a hospitalist-run, academic MPS resulted in a large volume of procedures, high rate of trainee participation, low rates of complications, and significant increase in procedural charges over five years. Wider adoption of this model has the potential to further improve patient procedural care and trainee education.