Specialties performing paracentesis procedures at university hospitals: Implications for training and certification

被引:16
作者
Barsuk, Jeffrey H. [1 ]
Feinglass, Joe [1 ]
Kozmic, Sarah E. [1 ]
Hohmann, Samuel F. [2 ]
Ganger, Daniel [3 ]
Wayne, Diane B. [1 ]
机构
[1] Northwestern Univ, Dept Med, Feinberg Sch Med, Chicago, IL 60611 USA
[2] Univ HealthSyst Consortium, Chicago, IL USA
[3] Northwestern Univ, Feinberg Sch Med, Div Hepatol, Chicago, IL 60611 USA
关键词
CLINICAL COMORBIDITY INDEX; SIMULATION-BASED EDUCATION; SUPERVISION; BEDSIDE; MODEL;
D O I
10.1002/jhm.2153
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Paracentesis procedure competency is not required for internal medicine or family medicine board certification, and national data show these procedures are increasingly referred to interventional radiology (IR). However, practice patterns at university hospitals are less clear. OBJECTIVE To evaluate which specialties perform paracentesis procedures at university hospitals, compare characteristics of patients within each specialty, and evaluate length of stay (LOS) and hospital costs. DESIGN, SETTING, PATIENTS Observational administrative database review of patients with liver disease who underwent paracentesis procedures in hospitals participating in the University HealthSystem Consortium (UHC) Database from January 2010 through December 2012. UHC is an alliance of 120 academic medical centers and their 290 affiliated hospitals. EXPOSURE Patients with liver disease who underwent inpatient paracentesis procedures. MEASUREMENTS We compared characteristics of patients who underwent paracentesis procedures by physician specialty, modeling the effects of patient characteristics on the likelihood of IR referral. We also analyzed LOS and hospital costs among patients with a >20% predicted probability of IR referral. RESULTS There were 97,577 paracentesis procedures performed during 70,862 hospital stays in 204 hospitals. IR performed 29% of paracenteses versus 49% by medicine and medicine subspecialties including gastroenterology/hepatology. Patients who were female, obese, and those with lower severity of illness were more likely to be referred to IR. Patients with a medicine or gastroenterology/hepatology paracentesis had a similar LOS compared to IR. Hospital costs were an estimated as $1308 less for medicine and $803 less for gastroenterology/hepatology compared to admissions with IR procedures (both P = 0.0001). CONCLUSIONS Internal medicine- and family medicine-trained clinicians frequently perform paracentesis procedures on complex inpatients but are not currently required to be competent in the procedure. Increasing bedside paracentesis procedures may reduce healthcare costs. Journal of Hospital Medicine 2014;9:162-168. (c) 2014 Society of Hospital Medicine
引用
收藏
页码:162 / 168
页数:7
相关论文
共 34 条
  • [1] American Board of Internal Medicine, INT MED POL
  • [2] [Anonymous], 2006, AM J MED
  • [3] Clinical Outcomes after Bedside and Interventional Radiology Paracentesis Procedures
    Barsuk, Jeffrey H.
    Cohen, Elaine R.
    Feinglass, Joe
    McGaghie, William C.
    Wayne, Diane B.
    [J]. AMERICAN JOURNAL OF MEDICINE, 2013, 126 (04) : 349 - 356
  • [4] Barsuk Jeffrey H, 2012, J Grad Med Educ, V4, P23, DOI 10.4300/JGME-D-11-00161.1
  • [5] Simulation-based education with mastery learning improves residents' lumbar puncture skills
    Barsuk, Jeffrey H.
    Cohen, Elaine R.
    Caprio, Timothy
    McGaghie, William C.
    Simuni, Tanya
    Wayne, Diane B.
    [J]. NEUROLOGY, 2012, 79 (02) : 132 - 137
  • [6] Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit
    Barsuk, Jeffrey H.
    McGaghie, William C.
    Cohen, Elaine R.
    O'Leary, Kevin J.
    Wayne, Diane B.
    [J]. CRITICAL CARE MEDICINE, 2009, 37 (10) : 2697 - 2701
  • [7] Mastery Learning of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows Using Simulation Technology and Deliberate Practice
    Barsuk, Jeffrey H.
    Ahya, Shubhada N.
    Cohen, Elaine R.
    McGaghie, William C.
    Wayne, Diane B.
    [J]. AMERICAN JOURNAL OF KIDNEY DISEASES, 2009, 54 (01) : 70 - 76
  • [8] Use of Simulation-Based Education to Reduce Catheter-Related Bloodstream Infections
    Barsuk, Jeffrey H.
    Cohen, Elaine R.
    Feinglass, Joe
    McGaghie, William C.
    Wayne, Diane B.
    [J]. ARCHIVES OF INTERNAL MEDICINE, 2009, 169 (15) : 1420 - 1423
  • [9] Incidence and Predictors of 30-Day Readmission Among Patients Hospitalized for Advanced Liver Disease
    Berman, Kenneth
    Tandra, Sweta
    Forssell, Kate
    Vuppalanch, Raj
    Burton, James R., Jr.
    Nguyen, James
    Mullis, Devonne
    Kwo, Paul
    Chalasani, Naga
    [J]. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2011, 9 (03) : 254 - 259
  • [10] Performance of procedures by nephrologists and nephrology fellows at US nephrology training programs
    Berns, Jeffrey S.
    O'Neill, W. Charles
    [J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2008, 3 (04): : 941 - 947