Barsuk Jeffrey H, Feinglass Joe, Kozmic Sarah E, Hohmann Samuel F, Ganger Daniel, Wayne Diane B
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Hosp Med. 2014 Mar;9(3):162-8. doi: 10.1002/jhm.2153. Epub 2014 Feb 3.
Paracentesis procedure competency is not required for internal medicine or family medicine board certification, and national data show these procedures are increasingly referred to interventional radiology (IR). However, practice patterns at university hospitals are less clear.
To evaluate which specialties perform paracentesis procedures at university hospitals, compare characteristics of patients within each specialty, and evaluate length of stay (LOS) and hospital costs.
DESIGN, SETTING, PATIENTS: Observational administrative database review of patients with liver disease who underwent paracentesis procedures in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through December 2012. UHC is an alliance of 120 academic medical centers and their 290 affiliated hospitals.
Patients with liver disease who underwent inpatient paracentesis procedures.
We compared characteristics of patients who underwent paracentesis procedures by physician specialty, modeling the effects of patient characteristics on the likelihood of IR referral. We also analyzed LOS and hospital costs among patients with a >20% predicted probability of IR referral.
There were 97,577 paracentesis procedures performed during 70,862 hospital stays in 204 hospitals. IR performed 29% of paracenteses versus 49% by medicine and medicine subspecialties including gastroenterology/hepatology. Patients who were female, obese, and those with lower severity of illness were more likely to be referred to IR. Patients with a medicine or gastroenterology/hepatology paracentesis had a similar LOS compared to IR. Hospital costs were an estimated as $1308 less for medicine and $803 less for gastroenterology/hepatology compared to admissions with IR procedures (both P = 0.0001).
Internal medicine- and family medicine-trained clinicians frequently perform paracentesis procedures on complex inpatients but are not currently required to be competent in the procedure. Increasing bedside paracentesis procedures may reduce healthcare costs.
内科或家庭医学委员会认证并不要求具备腹腔穿刺术操作能力，且全国数据显示这些操作越来越多地被转交给介入放射科（IR）。然而，大学医院的实践模式尚不清楚。
评估大学医院中哪些专科进行腹腔穿刺术，比较各专科患者的特征，并评估住院时间（LOS）和医院费用。
设计、设置、患者：对2010年1月至2012年12月期间在参与大学卫生系统联盟（UHC）数据库的医院中接受腹腔穿刺术的肝病患者进行观察性管理数据库回顾。UHC是一个由120个学术医疗中心及其290家附属医院组成的联盟。
接受住院腹腔穿刺术的肝病患者。
我们比较了按医生专科进行腹腔穿刺术的患者特征，模拟患者特征对IR转诊可能性的影响。我们还分析了预测IR转诊概率>20%的患者的住院时间和医院费用。
204家医院的70862次住院期间共进行了97577次腹腔穿刺术。IR进行了29%的腹腔穿刺术，而内科及包括胃肠病学/肝病学在内的内科亚专科进行了49%。女性、肥胖患者以及病情较轻的患者更有可能被转诊至IR。接受内科或胃肠病学/肝病学腹腔穿刺术的患者与接受IR治疗的患者住院时间相似。与接受IR手术的入院患者相比，内科患者的医院费用估计少1308美元，胃肠病学/肝病学患者少803美元（P均=0.0001）。
接受内科和家庭医学培训的临床医生经常对复杂的住院患者进行腹腔穿刺术，但目前并不要求他们具备该操作的能力。增加床边腹腔穿刺术可能会降低医疗成本。
