Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
J Hosp Med. 2021 Apr;16(4):230-235. doi: 10.12788/jhm.3590.
As general internists practicing in the inpatient setting, hospitalists at many institutions are expected to perform invasive bedside procedures, as defined by professional standards. In reality, hospitalists are doing fewer procedures and increasingly are referring to specialists, which threatens their ability to maintain procedural skills. The discrepancy between expectations and reality, especially when hospitalists may be fully credentialed to perform procedures, poses significant risks to patients because of morbidity and mortality associated with complications, some of which derive from practitioner inexperience.
We performed a structured search of the peer-reviewed literature to identify articles focused on hospitalists performing procedures.
Our synthesis of the literature characterizes contributors to hospitalists' procedural competency and discusses: (1) temporal trends for procedures performed by hospitalists and their associated referral patterns, (2) data comparing use and clinical outcomes of procedures performed by hospitalists compared with specialists, (3) the lack of nationwide standardization of hospitalist procedural training and credentialing, and (4) the role of medical procedure services, although limited in supportive evidence, in concentrating procedural skill and mitigating risk in the hands of a few well-trained hospitalists.
We conclude with recommendations for hospital medicine groups to ensure the safety of hospitalized patients undergoing bedside procedures.
作为在住院环境中执业的普通内科医生，许多机构的医院医生都需要按照专业标准进行有创的床边操作。但实际上，医院医生进行的操作越来越少，他们越来越多地将患者转介给专科医生，这威胁到了他们维持操作技能的能力。这种期望与现实之间的差距，尤其是当医院医生可能有资格进行手术时，会给患者带来重大风险，因为并发症会导致发病率和死亡率上升，其中一些是由于医生经验不足造成的。
我们对同行评议文献进行了结构化搜索，以确定专注于医院医生进行操作的文章。
我们对文献的综合分析描述了影响医院医生操作能力的因素，并讨论了：（1）医院医生进行的操作的时间趋势及其相关转诊模式；（2）比较医院医生与专科医生进行的操作的使用情况和临床结果的数据；（3）缺乏全国范围内对医院医生操作培训和认证的标准化；（4）医疗操作服务的作用，尽管证据有限，但它在少数经过良好培训的医院医生手中集中操作技能和降低风险方面发挥了作用。
我们最后提出了医院医学团队的建议，以确保接受床边操作的住院患者的安全。
