title: Impact of a bedside procedure service on general medicine inpatients: A firm-based trial.
abstract: BACKGROUND
  Procedure services may improve the training of bedside procedures. However, little is known about how procedure services may affect the demand for and success of procedures performed on general medicine inpatients.
  
  
  OBJECTIVE
  Determine whether a procedure service affects the number and success of 4 bedside procedures (paracentesis, thoracentesis, lumbar puncture, and central venous catheterization) attempted on general medicine inpatients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Large public teaching hospital.
  
  
  METHODS
  Nineteen hundred and forty-one consecutive admissions to the general medicine service.
  
  
  METHODS
  A bedside procedure service was offered to physicians from 1 of 3 firms for 4 weeks. This service then crossed over to physicians from the other 2 firms for another 4 weeks.
  
  
  METHODS
  Data on all procedure attempts were collected daily from physicians. We examined whether the number of attempts and the proportion of successful attempts differed based on whether firms were offered the beside procedure service.
  
  
  RESULTS
  The number of procedure attempts was 48% higher in firms offered the service (90 versus 61 per 1000 admissions; RR 1.48, 95% CI 1.06-2.10; P = .030). More than 85% of the observed increase was a result of procedures with therapeutic indications. There were no differences between firms in the proportions of successful attempts or major complications.
  
  
  CONCLUSIONS
  The availability of a procedure service may increase the overall demand for bedside procedures. Further studies should refine the indications for and anticipated benefits from these commonly performed invasive procedures.
authors.affiliation: Department of Medicine, John H. Stroger Jr. Hospital of Cook County, and Rush Medical College, Chicago, Illinois 60612, USA. brian_lucas@rush.edu
authors.forename: Brian P
authors.initials: BP
authors.lastname: Lucas
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Asbury
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: Kuenok
authors.initials: K
authors.lastname: Lee
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kumapley
authors.forename: Benjamin
authors.initials: B
authors.lastname: Mba
authors.forename: Shane
authors.initials: S
authors.lastname: Borkowsky
authors.forename: Abdo
authors.initials: A
authors.lastname: Asmar
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000706:statistics & numerical data; D002641:Chicago; D002983:Clinical Competence; D003657:Decision Making; D006300:Health Services Misuse; D006301:Health Services Needs and Demand; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D019152:Paracentesis / Q000009:adverse effects / Q000706:statistics & numerical data; D010865:Pilot Projects; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011787:Quality of Health Care; D013129:Spinal Puncture / Q000009:adverse effects / Q000706:statistics & numerical data; D013663:Teaching / Q000379:methods*