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Implementing an Ultrasound Procedure Team in an Internal Medicine Residency: Exposing Residents to Procedures Without Increasing Patient Risk FREE TO VIEW

David Wisa; Khan Samad; Chowdhury Nazif
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Lenox Hill Hospital, Johnson City, NY

Chest. 2014;146(4_MeetingAbstracts):562A. doi:10.1378/chest.1993862
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SESSION TITLE: Patient Safety Initiative Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: We sought to determine the complication rate after a dedicated procedure team was implemented in hopes of superior patient care alongside improved resident training at our facility.

METHODS: The procedure team at our institution was implemented in the 2012 academic year. The team comprised of an attending physician and senior resident whose main clinical responsibilities were to perform basic procedures such as central venous catheter placement, thoracentesis, paracentesis, lumbar puncture and arthrocentesis. This study was specifically looking at central venous catheters. We conducted a retrospective review of all central venous catheter placements in our institution in 2012. The study was a quality improvement project involving all 24 categorical residents. The procedure team was started exactly mid-way through the year on July 1st. We excluded PICC, femoral, umbilical and tunneled catheters. We reviewed for complications of improper placement and pneumothorax.

RESULTS: A total of 310 suitable cases were selected. Prior to 7/1, 134 cases were performed; 35 by residents (26%) while 99 (74%) by nonresident. In comparison, after 7/1, 176 cases were performed;, 91 (52%) by residents while 85 (48%) by nonresidents. Prior to 7/1, residents had one complication (arterial placement; 1/35(2.8%)). Non-residents had one complication (pneumothorax; 1/99 (1%)). After 7/1 residents had 2 complications (improper placement; 2/91 (2.2%). Non-residents had 3 complications (2 improperly placed/1 pneumothorax; 3/85 (3.6%)).

CONCLUSIONS: Through a new dedicated procedure team, we were able to drastically improve resident exposure to central venous catheter placements (from 35 to 99) over a 6 month period. The complication rate had decreased among residents while slightly increasing among nonresidents, keeping in mind that only a quarter of cases were performed by residents before, while more than half of the cases after, 7/1/2012.

CLINICAL IMPLICATIONS: Inroducing a dedicated procedure team with the use of ultrasound in central venous catheter placement not only improved patient outcome but also yields more competent residents. This should service as a step towards routine use of ultrasound guidance, as well as the autonomy of residents to perform said procedures without supervision. In the future, we will be able to expand this study to all procedures that the team performs.

DISCLOSURE: The following authors have nothing to disclose: David Wisa, Khan Samad, Chowdhury Nazif

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