title: The impact of a medical procedure service on patient safety, procedure quality and resident training opportunities.
abstract: 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.
  
  
  METHODS
  Retrospective cohort analysis comparing characteristics and outcomes of procedures performed by the MPS versus the primary medical service.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: The Pulmonary Center, Boston University School of Medicine, 72 E. Concord Street, R-304, Boston, MA, 02118, USA, mtukey@bu.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Tukey
authors.forename: Renda Soylemez
authors.initials: RS
authors.lastname: Wiener
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards*; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies