Expansion of hospital medicine procedure services: Better or just more?

Abstract

Many hospital medicine programs around the country have implemented hospital medicine bedside procedure services (HMPS) to facilitate timely performance of common bedside procedures, such as paracentesis, thoracentesis, central venous catheter placement, and lumbar puncture. 1 Some have successfully added different procedures, such as chest tube placement. 2 HMPS also commonly perform diagnostic point-of-care ultrasound to evaluate for ascites and pleural fluid and bring internal medicine expertise to evaluate the appropriateness, risk, and necessity of requested procedures. Studies evaluating the patient experience, safety, and other outcomes related to HMPS have demonstrated equivalence when compared to Interventional Radiology and other groups (such as resident or hospital medicine teams) commonly performing procedures. 1,3 This model has helped foster an era of increased focus on bedside procedures by hospitalists, improved skill development for trainees, and likely improved quality and timeliness of care. 4

Beyond “Can we?”

“…Any study designed to assess the benefits of placement of midline versus peripheral angiocaths in the internal jugular will need to take into consideration the ethical question of informed patient consent for research. This need is in addition to our other calls to weigh the benefits of expanding HMPS and evaluating whether this would be better or just one more option 5 . If evaluating a HMPS overall, gaining patient consent for enrolling in a registry or similar structure should be considered.…”

“…This need is in addition to our other calls to weigh the benefits of expanding HMPS and evaluating whether this would be better or just one more option. 5 If evaluating a HMPS overall, gaining patient consent for enrolling in a registry or similar structure should be considered.…”