Umpierrez Adrian P, Swartz Sheila, Puetz Joseph, Voigt Lara, Madenberg Devin, Franco Sadud Ricardo
Department of Medicine Emory University.
Department of Medicine Medical College of Wisconsin.
J Brown Hosp Med. 2025 Jan 1;4(1):23-29. doi: 10.56305/001c.127259. eCollection 2025.
Hospitalized patients frequently require various medical procedures, including lumbar punctures, paracenteses, and pulmonary drains, with significant annual volumes in the U.S. While bedside procedures are generally safe, their complication rates range from 0.1% to 3%, depending on the procedure. The Medicine Bedside Procedure Service (MBPS) at the Medical College of Wisconsin/Froedtert Health System was established as a standalone service in 2015 to enhance the training of Internal Medicine (IM) residents in common bedside procedures and Point of Care Ultrasound (POCUS), while also aiming to reduce patient wait times for procedures and length of hospital stays. The study aimed to evaluate the development and implementation of the MBPS, focusing on the characteristics of the first 12,000 procedural encounters, the educational impact on IM residents, and the service's effects on patient outcomes. This retrospective study analyzed 12,387 procedural encounters involving 6,942 unique patients from September 2015 to June 2022. Patient demographics were assessed, including age, sex, race, language, payer status, and comorbidities. Descriptive statistics were utilized to summarize the data, including means and standard deviations for continuous variables and frequencies for categorical variables. The patient demographic indicated a predominance of males (53.1%), non-Hispanic Whites (68.8%), and a significant portion covered by Medicaid (71.6%). The average patient age was 64.7 years. The MBPS performed an average of 5.2 procedures per day, with paracentesis (34.6%), thoracentesis (27.3%), and lumbar puncture (21.1%) being the most common procedures. The overall complication rate was low at 0.3%, with the majority of complications occurring in thoracentesis (56%). The MBPS has contributed to the educational development of IM residents, evidenced by their increased proficiency and procedural certification rates, while also improving patient outcomes, including reduced lengths of stay and hospital costs. The service has optimized patient flow and increased satisfaction through timely and safe procedural care. Despite challenges in fostering a supportive culture for bedside procedures and ensuring effective communication with interventional radiology, the MBPS exemplifies the advantages of bedside procedures. Moving forward, plans include expanding into outpatient settings and incorporating advanced POCUS capabilities to enhance diagnostic and therapeutic decision-making at the bedside. Limitations of this single-center study and lack of comparative groups suggest the need for further research to validate these findings across diverse healthcare settings.
住院患者经常需要进行各种医疗程序，包括腰椎穿刺、腹腔穿刺和胸腔引流，在美国每年的实施量都很大。虽然床边操作一般是安全的，但根据操作不同，其并发症发生率在0.1%至3%之间。威斯康星医学院/弗罗伊德特医疗系统的内科床边操作服务（MBPS）于2015年作为一项独立服务设立，旨在加强内科（IM）住院医师在常见床边操作和床旁超声（POCUS）方面的培训，同时也旨在减少患者等待操作的时间和住院时间。该研究旨在评估MBPS的发展和实施情况，重点关注前12000次操作的特点、对IM住院医师的教育影响以及该服务对患者结局的影响。这项回顾性研究分析了2015年9月至2022年6月期间涉及6942名独特患者的12387次操作。评估了患者的人口统计学特征，包括年龄、性别、种族、语言、付款人状况和合并症。采用描述性统计方法汇总数据，包括连续变量的均值和标准差以及分类变量的频率。患者人口统计学特征显示男性占主导（53.1%），非西班牙裔白人占主导（68.8%），且很大一部分由医疗补助覆盖（71.6%）。患者的平均年龄为64.7岁。MBPS平均每天进行5.2次操作，其中腹腔穿刺（34.6%）、胸腔穿刺（27.3%）和腰椎穿刺（21.1%）是最常见的操作。总体并发症发生率较低，为0.3%，大多数并发症发生在胸腔穿刺中（56%）。MBPS促进了IM住院医师的教育发展，表现为他们的熟练程度提高和操作认证率上升，同时也改善了患者结局，包括缩短住院时间和降低住院费用。该服务通过及时、安全的操作护理优化了患者流程并提高了满意度。尽管在营造支持床边操作的文化以及确保与介入放射学的有效沟通方面存在挑战，但MBPS体现了床边操作的优势。展望未来，计划包括扩展到门诊环境并纳入先进的POCUS功能，以加强床边的诊断和治疗决策。这项单中心研究的局限性以及缺乏对照组表明需要进一步研究，以在不同的医疗环境中验证这些发现。
