Creation of a medical procedure service in a tertiary medical center: Blueprint and procedural outcomes

Background: Medical Procedure Services (MPS) may represent a solution to the educational gap in procedural training among internal medicine residents and the unmet need for the clinical provision of non-urgent inpatient procedures. However, there is little guidance available to help launch an MPS. Furthermore, procedural outcomes from a newly initiated MPS, including those comparing trainees versus attending physicians, are lacking. Objective: To describe the blueprint used in the design, implementation, and ongoing oversight of an MPS and to report its procedural outcomes. Design, Settings and Participants: Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Intervention: The launch of an MPS at a large tertiary academic hospital. Main Outcome and Measures: 6,152 procedural consultations resulting in 5,320 attempted procedures over a four-and-a-half year period. Results: The primary proceduralist was a supervised resident in 58.7% (3124 /5,320) and an attending in 41.3% (2,196/5,320) of procedures. The overall success rate was 91.1% (95% CI: 90.3-91.9%) and the major complication rate was 0.7% (95% CI: 0.5-1.0%). There was no difference in the mean number of attempts required to complete a procedure (1.6 vs 1.5 attempts, p=0.68) and the complication rates between supervised residents and attending proceduralists, respectively (20/3,124 vs 20/2,196, p=0.26). Conclusion: At a tertiary academic medical center, the implementation and maintenance of MPS is feasible, safe, and results in high rates of successful procedures performed by supervised residents. Procedures performed by supervised residents require comparable number of attempts for completion and carry similar risks as those performed alone by attendings.