"Transforming Care at the Bedside: The Impact of the Medicine Bedside Procedure Service on Resident Training and Patient Outcomes".

Abstract

Background: 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. Objective: 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. Methods: 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. Results: 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%). Conclusions: 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.