SIMPLE procedures: Survey of Internal Medicine Providers' Limitations and Experiences with procedures and medical procedure services

IF 2.4 4区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of hospital medicine Pub Date : 2024-06-30 DOI:10.1002/jhm.13443

Joséphine A. Cool MD, Andrew R. Lai MD, MPH, Henry Kramer MD, Amiran Baduashvili MD

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Abstract

Background

In response to a decline in bedside procedures performed by hospitalists, some hospital medicine groups have created medical procedure services (MPSs) concentrating procedures under the expertise of trained hospitalist-proceduralists.

Objectives

To characterize the structure, breadth, and heterogeneity of academic medical center MPSs, as well as compare the procedural landscape for groups with and without an MPS.

Methods

The Survey of Internal Medicine Providers' Limitations and Experiences with Procedures and MPSs, is a cross-sectional study, conducted in the United States and Canada through a web-based survey administered from October 2022 to March 2023. We used convenience and snowball sampling to identify eligible study participants. The survey explored presence of MPS, procedure volumes, patient safety, and educational practices. For MPSs, we explored onboarding, staffing, skill maintenancy, funding, and barriers to growth.

Results

Forty institutions (response rate 97.5%), represented by members of the Procedural Research and Innovation for Medical Educators (PRIME) consortium participated in the survey. MPSs were found in 75% of the surveyed institutions. Most MPSs (97%) involved trainees and were staffed by internists (100%) who often had additional clinical duties (70%). The majority (83%) of MPSs used checklists and procedural safety guidelines, but only 53% had a standardized process for tracking complications. There was significant variability in determining procedural competency and supervising trainees. Groups with an MPS reported higher procedure volume compared to those without.

Conclusions

MPSs were highly prevalent among the participating institutions, offered a broad array of bedside procedures, and often included trainees. There was a high variability in funding models, procedure volumes, patient safety practices, and skill maintenance requirements.

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SIMPLE 程序：内科医生对程序和医疗程序服务的限制和经验调查。

背景：为了应对住院医师床旁手术的减少，一些医院医疗集团建立了医疗程序服务（MPS），将手术集中在训练有素的住院医师-程序专家的专业领域：目的：描述学术医疗中心 MPS 的结构、广度和异质性，并比较有 MPS 和没有 MPS 的医疗集团的手术情况：内科医疗服务提供者在程序和 MPS 方面的局限性和经验调查》是一项横断面研究，于 2022 年 10 月至 2023 年 3 月在美国和加拿大通过网络调查进行。我们采用了方便抽样和滚雪球抽样的方法来确定符合条件的研究参与者。调查内容包括是否存在 MPS、手术量、患者安全和教育实践。对于 MPS，我们调查了入职、人员配备、技能保持、资金和发展障碍：由医学教育者程序研究与创新联合会（PRIME）成员代表的 40 家机构（回复率 97.5%）参与了调查。75%的被调查机构拥有 MPS。大多数 MPS（97%）都有受训人员参与，并由内科医生（100%）负责，而这些内科医生通常还承担额外的临床职责（70%）。大多数（83%）的 MPS 使用核对表和程序安全指南，但只有 53% 的 MPS 有跟踪并发症的标准化流程。在确定手术能力和监督受训者方面存在很大差异。与未设立MPS的小组相比，设立了MPS的小组报告的手术量更高：MPS在参与机构中非常普遍，提供广泛的床边手术，通常包括受训人员。在资助模式、手术量、患者安全实践和技能维护要求方面存在很大差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.

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