From the 2018 HVPAA National Conference
Kevin Hauck (NYU Langone Health), Nicole Adler (NYU Langone Health)
Many procedures that were previously done at the bedside by hospitalists have become the exclusive province of Interventional Radiology. As hospitalists have become more reliant on IR, they have lost the ability to do these procedures. This causes delays with a subsequent increase in LOS and delay in diagnosis.
The objective of this intervention was to increase hospitalist comfort in performing simple bedside procedures including lumbar puncture and paracentesis, create a proceduralist team, and increase the proportion of bedside procedures performed by the primary team without consulting IR.
All hospitalists at a large, academic medical center were offered training in simple bedside procedures. Training consisted of a one-hour self-study didactic session and a single four-hour session taught by critical care and emergency medicine faculty in a simulation lab. Using simulated patients, participants were taught how to perform paracentesis, and lumbar puncture. The basics of bedside ultrasound were also reviewed with a standardized patient. Following training, new workflow was created to allow a dedicated hospitalist to supervise procedures on housestaff medicine teams and perform these procedures directly on medicine teams without housestaff. To fill in any gaps in the ability of the hospitalist to perform these procedures, a standardized backup system was created.
A total of 24 hospitalists underwent the initial training in bedside procedures. A new role with 24-hour coverage, the Hospitalist Proceduralist, was created. Hospitalists who underwent training began rotation on the inpatient proceduralist service.
A new report was created in the electronic medical record to record the number of bedside procedures performed on the medicine service by hospitalists and with Interventional Radiology. Early results indicate that approximately 1/3 of procedures are now being done by hospitalists instead of Interventional Radiology. The final results of this metric are pending.
This project demonstrated the feasibility of creating an inpatient hospitalist proceduralist service to both supervise housestaff and directly perform simple bedside procedures without the involvement of Interventional Radiology. Further research is needed to clarify the impact on length of stay, the total number of procedures done at the bedside, as well as the safety and efficacy of this intervention.
Implications for the Patient
This project demonstrates that with training and coordination, bedside procedures can be brought back to the bedside. Future iterations of this project are planned to include bedside administration of intrathecal chemotherapy.