Jones & Bartlett Learning Medicine Blog

    Simulation-Based Procedural Training Improves Job & Patient Satisfaction

    Posted by Joseph Esherick on Feb 29, 2012 5:33:55 PM

    Dr. Joseph Esherick Monthly Blog – February 2012

    Are you a hospitalist who would like to incorporate procedures into your practice but don’t feel competent or confident in your skills?  Are you a hospitalist who does procedures so infrequently that you feel more comfortable referring your patients to a specialist for such procedures?  Are you a hospitalist who believes that you can get better reimbursement seeing more inpatients rather than incorporating hospital procedures into your practice?  Are you a hospitalist who believes that doing procedures will decrease your job satisfaction?  These are a few of many scenarios and myths that prevent hospitalists from performing bedside procedures.

    Hospitalists who perform procedures enjoy their jobs more than those who do not.   In one Canadian study of over 19,000 physicians, the degree of job satisfaction was directly linked to the range of procedures performed by the physician.[1]

    Additionally, patients feel better when the bedside procedures are performed by their primary physician with whom they have developed a rapport.  There are a few reasons for this.  Frequently, procedures performed by a specialist, especially an interventional radiologist, require that the patient has long waits, is taken away from their room, their nurse, and their family.  Furthermore, patients have often developed a relationship and trust with their primary inpatient physician and feel more comfort when they are performing the procedure rather than a complete stranger.

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    Topics: primary care, Physician, American Board of Internal Medicine, Dr. Joseph Esherick, simulation-based training, American College of Physicians, bedside procedures, Hospital Medicine Blog, hospital medicine, hospitalist, patient, point-of-care, Society of Hospital Medicine, surgical skills

    Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

    Posted by Joseph Esherick on Jul 15, 2011 11:08:52 AM

    Dr. Joseph Esherick Monthly Blog – July 2011

    The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891[1]This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or the L2-3 interspinous spaces.  The landmark-guided technique of lumbar puncture is usually successful in experienced hands as long as the patient is not obese, pregnant, edematous, or have scoliosis, degenerative joint disease, or a history of lumbar spine surgery.  Patients who have any of these characteristics or conditions can lead to more difficult landmark-guided lumbar punctures.  It is in these cases when bedside ultrasound can increase the success rate of lumbar punctures.[2,3,4,5]    

    Ultrasound-guided regional neuraxial anesthesia has been described in the anesthesia literature since 1971.[6]   The literature reports a reduction in the number of attempts, need for repositioning, and interspaces accessed compared with landmark-guided spinal or epidural anesthesia.[7,8]  The use of bedside ultrasound to help guide difficult lumbar punctures has spread to the emergency room, ICU, and the hospital wards over the last 7 years.[9]   Observational studies have demonstrated that lumbar landmarks can be correctly identified using ultrasound about 76% of the time when they are difficult to palpate.[2,3,9]

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    Topics: Dr. Joseph Esherick, emergency physician, Heinrich Quincke, Authors, bedside ultrasound, Hospital Medicine Blog, emergency medicine, hospital medicine, hospitalist, landmark-guided, lumbar puncture

    A Simple Checklist for Central Lines Saves Lives and Money

    Posted by Joseph Esherick on Jun 28, 2011 8:28:07 AM

    Dr. Joseph Esherick Monthly Blog - June 2011

    Safety checklists have been adopted by numerous industries to prevent errors and save lives.  Checklists have been used for decades by industries as diverse as the aviation industry, construction companies, and professional chefs to prevent mistakes.  In medicine, checklists have been used in the operating room to prevent surgical errors and for central line placement to prevent catheter-related blood stream infections (CRBSIs).

    The pioneer of safety checklists in medicine is Dr. Peter Provonost who spearheaded the Michigan Keystone ICU Project that ended in 2006[1].   The checklist used for central venous catheter placement is simple and involves only five key steps that are rooted in evidence-based medicine:  wash your hands; cleanse the insertion site thoroughly with chlorhexidine; maximal barrier precautions (wear a mask covering the nose and mouth, a cap covering all your hair, sterile gown, sterile gloves and use a wide sterile drape over the patient); a nurse or observer is empowered to stop the procedure if there is any break in sterile technique; and there is a daily review of central line necessity.

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    Topics: medicine, Dr. Joseph Esherick, Authors, Keystone Project, CRBSI, Global Health Blog, Dr. Peter Provonost, hospital medicine, hospitalist, ICU, safety checklist

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