Chapter 113. Introduction to Procedures

1. How can hospitalists be frontline defenders of procedural patient safety?

2. What should hospitalists ask themselves before performing any procedure safely?

3. What are additional considerations for training and supervising trainees? What is the role of simulation?

4. What is state of the art in procedural competence assessment?

5. How can hospitalists have an impact on an institutional policy and practice in procedures?

Though traditionally considered a nontechnical role, hospitalists are increasingly performing procedures. In small hospitals without extensive specialty resources, hospitalists are often firstline operators of procedures. Continuing medical education courses on common procedures are being geared toward hospitalists. Procedure services staffed by hospitalists are emerging around the country, leading some hospitalists to call themselves proceduralists. In light of the fact that technical errors are a common cause of inpatient morbidity and mortality, hospitalists are well positioned to improve patient safety.

Before performing any procedure, a hospitalist must ask him- or herself the following questions to reduce potential procedural errors (Table 113-1).

Considerations for using interventional radiology even before attempting at the bedside include: distorted anatomy due to prior surgeries (eg, posterior spinal fusion for lumbar punctures), small fluid volumes, previous failed attempts, and a narrow window for tolerating complications (eg, central lines in patients on positive-pressure ventilation).

For the hospitalist working in a teaching hospital, there are additional considerations when supervising an individual trainee performing a procedure. He or she should perform a needs assessment first to ...