Lucas Brian P, Asbury Joseph K, Wang Yue, Lee Kuenok, Kumapley Rudolf, Mba Benjamin, Borkowsky Shane, Asmar Abdo
Department of Medicine, John H. Stroger Jr. Hospital of Cook County, and Rush Medical College, Chicago, Illinois 60612, USA.
J Hosp Med. 2007 May;2(3):143-9. doi: 10.1002/jhm.159.
Procedure services may improve the training of bedside procedures. However, little is known about how procedure services may affect the demand for and success of procedures performed on general medicine inpatients.
Determine whether a procedure service affects the number and success of 4 bedside procedures (paracentesis, thoracentesis, lumbar puncture, and central venous catheterization) attempted on general medicine inpatients.
Prospective cohort study.
Large public teaching hospital.
Nineteen hundred and forty-one consecutive admissions to the general medicine service.
A bedside procedure service was offered to physicians from 1 of 3 firms for 4 weeks. This service then crossed over to physicians from the other 2 firms for another 4 weeks.
Data on all procedure attempts were collected daily from physicians. We examined whether the number of attempts and the proportion of successful attempts differed based on whether firms were offered the beside procedure service.
The number of procedure attempts was 48% higher in firms offered the service (90 versus 61 per 1000 admissions; RR 1.48, 95% CI 1.06-2.10; P = .030). More than 85% of the observed increase was a result of procedures with therapeutic indications. There were no differences between firms in the proportions of successful attempts or major complications.
The availability of a procedure service may increase the overall demand for bedside procedures. Further studies should refine the indications for and anticipated benefits from these commonly performed invasive procedures.
操作服务可能会改善床边操作的培训。然而，关于操作服务如何影响普通内科住院患者所进行操作的需求和成功率，人们了解甚少。
确定操作服务是否会影响对普通内科住院患者尝试进行的4种床边操作（腹腔穿刺术、胸腔穿刺术、腰椎穿刺术和中心静脉置管术）的数量和成功率。
前瞻性队列研究。
大型公立教学医院。
普通内科服务的1941例连续入院患者。
为3个医疗团队中1个团队的医生提供为期4周的床边操作服务。之后，该服务转至另外2个团队的医生，再持续4周。
每天从医生处收集所有操作尝试的数据。我们根据各医疗团队是否获得床边操作服务，检查尝试次数和成功尝试比例是否存在差异。
获得该服务的医疗团队的操作尝试次数高出48%（每1000例入院患者中分别为90次和61次；相对危险度1.48，95%置信区间1.06 - 2.10；P = 0.030）。观察到的增加中超过85%是由具有治疗指征的操作导致的。各医疗团队在成功尝试比例或主要并发症方面没有差异。
操作服务的提供可能会增加对床边操作的总体需求。进一步的研究应明确这些常见侵入性操作的指征和预期益处。
