Characteristics and impact of bedside procedure services in the United States: A systematic review

Abstract

Background: Bedside procedure services are increasingly employed within internal medicine departments to meet clinical needs and improve trainee education.Published literature on these largely comprises single-center studies; an updated systematic review is needed to synthesize available data.Purpose: This review examined published literature on the structure and function of bedside procedure services and their impact on clinical and educational outcomes (PROSPERO ID: 192466). Data Sources: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, multiple databases were searched for publications from 2000 to 2021.Study Selection, Data Extraction, and Data Synthesis: Thirteen single-center studies were identified, including 12 observational studies and 1 randomized trial. Data were synthesized in tabular and narrative format. Services were typically staffed by hospitalists or pulmonologists. At a minimum, each offered paracentesis, thoracentesis, and lumbar puncture. While there was considerable heterogeneity in service structures, these broadly fit either Model A (service performing the procedure) or Model B (service supervising the primary team). Procedure services led to increases in procedure volumes and self-efficacy among medical residents. Assessment of clinical outcomes was limited by heterogeneous definitions of complication rates and by sparse head-to-head data involving suitable comparators. Published data pointed to high success rates, low complication rates, and high patient satisfaction, with a recent study also demonstrating a decreased length of stay.Conclusions: There are relatively few published studies describing the characteristics of bedside procedure services and their impact on clinical and educational outcomes.Limited data point to considerable heterogeneity in service design, a positive impact on medical trainees, and a positive impact on patient-related outcomes.

Development of a Chief Resident Medical Procedure Service: a 10-Year Experience

“…The structure and curricular components of our MPS are similar to other attending physician–led MPS’s with respect to availability during weekdays and business hours only, types of procedures performed, and inclusion of both didactic and simulation-based training methods. 1 , 3 , 15 – 18 However, a chief resident–led MPS is a novel approach to overcome the limited availability of experienced attending physicians who can serve as proceduralists to establish an MPS. Our unique staffing model may allow other IM residency programs to gain the potential benefits of creating an MPS which include improvements in procedural volume, patient throughput, procedural education of trainees, and healthcare costs.…”

“…Since first described in 2004 1 , several institutions have implemented a medical procedure service (MPS) to improve timeliness of procedures and standardize training of procedures for internal medicine (IM) residents. 2 , 3 With the traditional MPS model, residents perform non-urgent bedside procedures under the supervision of an attending physician. 3 However, a critical barrier to starting an MPS has been a lack of experienced attending physicians with expertise in ultrasound-guided procedures.…”

“… 2 , 3 With the traditional MPS model, residents perform non-urgent bedside procedures under the supervision of an attending physician. 3 However, a critical barrier to starting an MPS has been a lack of experienced attending physicians with expertise in ultrasound-guided procedures. 4 …”

“…Few studies have evaluated the impact of MPS’s, and none describe an MPS led by chief residents. 3 Here we describe the development of an MPS led by 4 th -year IM chief residents and the 10-year outcomes.…”

Restoring “bedside” in the bedside procedures

“…The systematic review by Nandan et al in this issue of the Journal of Hospital Medicine captures the current state of evidence in support of establishing a dedicated bedside procedure service 3 . While the current data support the role of bedside procedure service in the education of internal medicine residents, data provide limited support for important clinical outcomes.…”