Shared Music Experiences During Bedside Neurosurgical Procedures: An ACGME-Sponsored Pilot Study on Fostering Patient-Clinician Alliance Through Music.

BACKGROUND: Bedside procedures represent a substantial proportion of the neurosurgical resident's responsibilities. Although music interventions in healthcare have classically been employed for the benefit of the patient, there is evidence in support of its positive effects on healthcare workers as well. OBJECTIVES: We aimed to create a novel framework-the shared music experience (SME)-which allows for patient and provider to discuss and mutually select a musical playlist during bedside procedural interventions. METHODS: A single-center prospective pilot study with nested design was carried out during a 6-month period. One sample was neurosurgery residents at our institution, while the other was patients undergoing nonemergent bedside procedures. Primary endpoints included change in neurosurgery residents' and patients' perception of patient-provider alliance. Secondary endpoints include quantitative and qualitative analysis of feedback from residents and patients about the SME framework. RESULTS: Twelve out of 13 (92.3%) eligible neurosurgery residents were enrolled. Twenty-eight SMEs were carried out. Twenty-six of 28 patients (92.9%) replied that they did enjoy the SME. Patients who partook in SMEs had a significant increase in metrics of patient-clinician alliance as measured by the mARM-5. All 7 residents who participated in at least 1 SME reported having enjoyed performing procedures within the framework and affirmed they would either ''often'' (2/7, 28.6%) or ''always'' (5/7, 71.4%) implement SME in future practice. CONCLUSIONS: The SME is a novel intervention that can be employed to help patients and providers find common ground through music and foster the patient-clinician relationship during bedside procedures.

The Safety of Pediatric Bedside Tracheostomy.

OBJECTIVE: Traditionally, pediatric tracheostomy has been viewed as a technically demanding procedure with a high complication rate, requiring the routine use of a formal operating room. Pediatric bedside tracheostomy in an intensive care unit (ICU) setting has not been widely reported, in contrast to the widespread adult bedside ICU tracheostomy. Transport of these critically ill, multiple life support systems dependent patients can be technically difficult, labor intensive, and potentially risky for these patients. Our study aimed to demonstrate the safety and efficacy of bedside tracheostomy in the pediatric ICU. MATERIALS AND METHODS: A retrospective analysis of all pediatric patients undergoing tracheostomy at a tertiary care center, between 1st of January 2013 and 31st of December 2019. RESULTS: During the study period, 117 pediatric patients underwent tracheostomy, 57 (48.7%) were performed bedside while 60 (51.3%) were performed in the operating room. Patients' ages ranged from 2 weeks to 17 years of age, with a median age of 16 months. No case of bedside tracheostomy necessitated a shift to the operating room. There was no difference in 30-day morbidity and mortality between the 2 groups. CONCLUSIONS: Our results suggest that pediatric open bedside tracheostomy in an ICU setting is a safe procedure, with similar complications and outcomes compared to tracheostomy performed in the operating room.

"This Won't Hurt a Bit": Is There a Role for Music in Bedside Procedures?

Music has played a long and storied role in clinical healing. However, the integration of music into clinical practice has been slow to gain traction, despite a recent meta-analysis demonstrating association of music interventions with clinically meaningful improvements in health-related quality of life. There is growing evidence that music has an active role in reducing patient pain and anxiety as well as affecting physiologic parameters, such as heart rate and blood pressure, in an ICU setting. Past studies have shown that incorporation of music into procedures in the operating room, radiology suites, and catheterization labs has reduced concurrent pharmacologic sedation requirements. In the age of patient-centered personalized medicine, we propose a call to action to implement an easily accessible, attainable checklist item offering a personal choice of music for patients during standardized bedside procedural training, to reduce anxiety, pain, and pharmacologic sedation and potentially improve clinical outcomes.

A one-week internal medicine procedure rotation designed to increase procedural opportunities and competency.

Background: Mounting literature describes increased procedure volume and improvement in procedural skills following implementation of procedural curricula and standardized rotations, generally requiring at least two weeks and incorporating dedicated lecture and didactic efforts. It is unknown whether shorter rotations that feature self-directed curricula can achieve similar outcomes.Methods: House staff participated in a one-week procedure rotation that coincided with preexisting non-clinical blocks ('jeopardy'). It provided an online curriculum as well as opportunities to perform procedures under interprofessional supervision. Inpatient procedure volumes were tallied before and after implementation of the rotation. During the first year of the rotation (academic year 2013-2014), house staff completed a knowledge-based quiz and a Likert-based survey (range 1-5) addressing confidence in performing procedures and satisfaction in procedural training. Results: Ninety-five of 99 house staff participated in the intervention (96% response rate). The total number of procedures performed by the Division of Hospital Medicine increased from an average of 74 per year over the four years prior to the introduction of the rotation to 291 per year during the third year of the rotation. The knowledge-based quiz score improved from a pre-intervention mean value of 50% to a post-intervention mean value of 61% (P = 0.020). Confidence in performing procedures improved from a pre-intervention mean value of 2.37 to a post-intervention mean value of 2.59 (P < 0.001). Satisfaction with procedural training improved from a pre-intervention mean value of 2.48 to a post-intervention mean value of 2.69 (P < 0.001).Conclusions: A one-week procedure rotation with a self-directed curriculum was introduced into the curriculum of an internal medicine residency program and was associated with increased procedure volume and sustained improvement in house staff knowledge, confidence, and satisfaction with procedural training.

Implementation of an academic hospital medicine procedure service: 5-year experience.

OBJECTIVES: Procedural complications are a common source of adverse events in hospitals, especially where bedside procedures are often performed by trainees. Medical procedure services (MPS) have been established to improve procedural education, ensure patient safety, and provide additional revenue for services that are typically referred. Prior descriptions of MPS have reported outcomes over one to 2 years. We aim to describe the implementation and 5-year outcomes of a hospitalist-run MPS. METHODS: We identified all patients referred to our MPS for a procedure over the 5-year span between 2014 and 2018. We manually reviewed all charts for complications of paracentesis, thoracentesis, central venous catheterization, and lumbar punctures performed by the MPS in both inpatient and outpatient settings. Annual charges for these procedures were queried using Current Procedural Terminology (CPT) codes. RESULTS: We identified 3,634 MPS procedures. Of these, ultrasound guidance was used in 3224 (88.7%) and trainees performed 2701 (74%). Complications identified included pneumothorax (3.7%, n = 16) for thoracentesis, post-dural puncture headache (13.9%, n = 100) and bleeding (0.1%, n = 1) for lumbar puncture, ascites leak for diagnostic (1.6%, n = 8) and large volume (3.7%, n = 56) paracentesis, and bleeding (3.5%, n = 16) for central venous catheter placement. Prior to initiation of the MPS, total annual procedural charges were $90,437. After MPS implementation, charges increased to a mean of $787,352 annually in the last 4 years of the study period. CONCLUSIONS: Implementation of a hospitalist-run, academic MPS resulted in a large volume of procedures, high rate of trainee participation, low rates of complications, and significant increase in procedural charges over 5 years. Wider adoption of this model has the potential to further improve patient procedural care and trainee education.

Repurposing a Small Community Hospital Surgical Residency Program in an Epicenter of the COVID-19 Pandemic.

BACKGROUND: COVID-19 put a stop to the operative experience of surgical residents, leaving reassignment of the team, to the frontlines. Each program has adapted uniquely; we discuss how our surgical education changed in our hospital. STUDY DESIGN: A retrospective review of changes in general surgery cases, bedside procedures, and utilization of residents before and during the pandemic. Procedures were retrieved from electronic medical records. Operating room (OR) cases 1 month before and 5 weeks after the executive order were collected. Triple lumen catheter (TLC), temporary hemodialysis catheter (HDC), and pneumothorax catheter (PC) insertions by surgical residents were recorded for 5 weeks. RESULTS: Before the pandemic, an average of 27.9 cases were done in the OR, with an average of 10.1 general surgery cases. From March 23 to April 30, 2020, the average number of cases decreased to 5.1, and general surgery cases decreased to 2.2. Elective, urgent, and emergent cases represented 83%, 14.6%, and 2.4% prior to the order and 66.7%, 15.1%, and 18.2%, respectively, after the order. Bedside procedures over 5 weeks totaled to 153, 93 TLCs, 39 HDCs, and 21 PCs. CONCLUSION: Repurposing the surgical department for the concerns of the pandemic has involved all surgical staff. We worked with other departments to allocate our team to areas of need and re-evaluated daily. The strengths of our team to deliver care and perform many bedside procedures allowed us to meet the demands posed by this disease while remaining as a cohesive unit.

Chest Physiotherapy in Acute Muco-obstructive Lung Disease.

Acute mucus plugging is a pulmonary emergency associated with increased mortality and often requires rapid bronchoscopic intervention which may not be readily available in all centers. Furthermore, the role and efficacy of alternate conventional measures such as mechanical percussive therapies are uncertain. Herein, we present a patient who rapidly progressed to respiratory distress; a chest X-ray revealed left lobar atelectasis highly suggestive of acute mucus plugging. In the absence of rapid bronchoscopic intervention, bedside chest percussion was initiated with improvement in clinical status. Our case demonstrates the successful utilization of chest physiotherapy in the resolution of acute mucus plugging in an urgent situation and highlights the need for careful attention to respiratory status in high-risk patients who are also undergoing fluid removal with dialysis therapies.

Ultrasound-guided Bedside Core Needle Biopsy: A Hospitalist Procedure Team's Experience.

Tissue pathology is integral for the diagnosis of various conditions, especially malignancy. Traditionally, biopsy procedures, including core needle biopsy (CNB), are performed by surgeons or radiologists. With the increasing utilization of point of care ultrasound (POCUS) skills and competence in bedside procedures by general internists, CNB can be safely moved to the patient's bedside with maintained accuracy and increased cost savings compared to traditional procedural methods. We aim to review the experience of our hospitalist-run medical procedure service in performing these ultrasound-guided procedures at the bedside.

Bedside Procedures in Hand Surgery.

Many conditions presenting to the hand surgeon are amenable to a bedside procedure rather than a formal operating room setting. With proper patient, room, and surgeon preparation, bedside procedures can provide an efficient and effective treatment for infection, trauma, and foreign bodies. Key differences from the operating room environment include patient expectations, analgesia, room setup, instrumentation, and surgical technique. This article provides a detailed primer for performing bedside procedures in the emergency department, outpatient clinic, and inpatient hospital room.

Procedural Experience and Confidence Among Graduating Medical Students.

OBJECTIVE: Bedside procedures are a vital component of patient care-particularly for surgeons. Anecdotal evidence and previous studies from individual institutions reveal a lack of exposure to these interventions in medical school. Our objective was to ascertain medical students' experience and confidence in performing bedside procedures. DESIGN: Our study included a multi-institutional, anonymous, Health Insurance Portability and Accountability Act-compliant electronic survey. Using a 4-point Likert scale, students were asked how many times they had performed each of 18 common bedside procedures and their anticipated confidence in completing it independently. Statistical analysis included student t test, Chi-square test, analysis of means, linear regression, and Bonferroni correction for multiple comparisons. PARTICIPANTS: In total, participants included 2260 4th year medical students at 17 allopathic medical schools. RESULTS: Overall, 644 students replied (28.5% response rate). Most respondents had never placed an arterial line (71%), central venous line (81%), chest tube (89%), intraosseous line (95%), injected a joint (63%), or had performed cardiopulmonary resuscitation (50%), a lumbar puncture (57%), paracentesis (66%), or thoracentesis (92%). Venipuncture, suturing, and Foley catheter placement were the only procedures which greater than 50% of students had performed more than 5 times. Significant correlation was observed (r = 0.7) between experience and confidence, with men being reported significantly higher experience and confidence than women (p < 0.0001). Students entering anesthesia and emergency medicine residencies reported significantly higher experience than those matriculating into other specialties (α = 0.003); students entering emergency medicine and surgery reported significantly higher confidence levels (α = 0.003). CONCLUSION: The largest survey of its kind, the present study demonstrates that medical students are underexposed to essential bedside procedures and feel uncomfortable performing them-a trend that has worsened over 25 years. Students entering surgical specialties have significantly higher levels of confidence, although a corresponding difference in experience was not observed.