The Impact of a Medical Procedure Service on Patient Safety,Procedure Quality and Resident Training Opportunities

BACKGROUND

At some academic hospitals, medical procedure services are being developed to provide supervision for residents performing bedside procedures in hopes of improving patient safety and resident education. There is limited knowledge of the impact of such services on procedural complication rates and resident procedural training opportunities.

OBJECTIVE

To determine the impact of a medical procedure service (MPS) on patient safety and resident procedural training opportunities.

DESIGN

Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service.

PARTICIPANTS

Consecutive adults admitted to internal medicine services at a large academic hospital who underwent a bedside medical procedure (central venous catheterization, thoracentesis, paracentesis, lumbar puncture) between 1 July 2010 and 31 December 2011.

MAIN MEASURES

The primary outcome was a composite rate of major complications. Secondary outcomes included resident participation in bedside procedures and use of “best practice” safety process measures.

KEY RESULTS

We evaluated 1,707 bedside procedures (548 by the MPS, 1,159 by the primary services). There were no differences in the composite rate of major complications (1.6 % vs. 1.9 %, p?=?0.71) or resident participation in bedside procedures (57.0 % vs. 54.3 %, p?=?0.31) between the MPS and the primary services. Procedures performed by the MPS were more likely to be successfully completed (95.8 % vs. 92.8 %, p?=?0.02) and to use best practice safety process measures, including use of ultrasound guidance when appropriate (96.8 % vs. 90.0 %, p?=?0.0004), avoidance of femoral venous catheterization (89.5 vs. 82.7 %, p?=?0.02) and involvement of attending physicians (99.3 % vs. 57.0 %, p?<?0.0001).

CONCLUSIONS

Although use of a MPS did not significantly affect the rate of major complications or resident opportunities for training in bedside procedures, it was associated with increased use of best practice safety process measures.