Examining Invasive Bedside Procedure Performance at an Academic Medical Center. South Med J 2016 Jul;109(7):402-7
Date
07/02/2016Pubmed ID
27364022Pubmed Central ID
PMC4933316DOI
10.14423/SMJ.0000000000000485Scopus ID
2-s2.0-84977261849 (requires institutional sign-in at Scopus site) 15 CitationsAbstract
OBJECTIVES: Explore the performance patterns of invasive bedside procedures at an academic medical center, evaluate whether patient characteristics predict referral, and examine procedure outcomes.
METHODS: This was a prospective, observational, and retrospective chart review of adults admitted to a general medicine service who had a paracentesis, thoracentesis, or lumbar puncture between February 22, 2013 and February 21, 2014.
RESULTS: Of a total of 399 procedures, 335 (84%) were referred to a service other than the primary team for completion. Patient characteristics did not predict referral status. Complication rates were low overall and did not differ, either by referral status or location of procedure. Model-based results showed a 41% increase in the average length of time until procedure completion for those referred to the hospital procedure service or radiology (7.9 vs 5.8 hours; P < 0.05) or done in radiology instead of at the bedside (9.0 vs 5.8 hours; P < 0.001). The average procedure cost increased 38% ($1489.70 vs $1023.30; P < 0.001) for referred procedures and 56% ($1625.77 vs $1150.98; P < 0.001) for radiology-performed procedures.
CONCLUSIONS: Although referral often is the easier option, our study shows its shortcomings, specifically pertaining to cost and time until completion. Procedure performance remains an important skill for residents and hospitalists to learn and use as a part of patient care.
Author List
Kay C, Wozniak EM, Szabo A, Jackson JLAuthors
Jeffrey L. Jackson MD Professor in the Medicine department at Medical College of WisconsinCynthia Kay MD Associate Professor in the Medicine department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Academic Medical CentersAdult
Aged
Female
Hospitalization
Humans
Internship and Residency
Male
Middle Aged
Paracentesis
Patients' Rooms
Point-of-Care Testing
Referral and Consultation
Spinal Puncture
Thoracentesis
United States
