Dr. Wachter convened a Department of Hospital Medicine case conference discussion of a real patient. He also led a simulated root cause analysis discussion of an actual medical error, which occurred at UCSF when the wrong patient was given an unnecessary cardiovascular physiology procedure scheduled for a different patient with a similar sounding name. Organized discussion of medical errors, led by UCSF hospitalists, take place weekly at the medical center.
In a hands-on procedure workshop in the library, Diane Sliwka, MD, who developed the hospitalist procedure service at UCSF, introduced the clinical benefits of using ultrasound diagnostic imaging to guide routine central line placements, paracentesis, and thoracentesis in hospitalized patients. She reviewed the basics of frequency, contrast, and sterile technique with ultrasound, and the visual and spatial orientation necessary to interpret the image on the screen. Participants used the equipment to locate pockets of ascites in the abdomen of a UCSF patient and frequent training volunteer known to have pleural effusions. Participants also practiced needle insertion technique with actual hospital equipment on prepared chicken carcasses.
“Ultrasound does enhance the safety of bedside procedures. Ultrasound basics are learnable with practice and give a new dimension of ‘sight’ to common bedside procedures,” Dr. Sliwka explained to the participants, 70% of whom had not used ultrasound for bedside procedures. “Where it’s available, you can learn to do it with a bit of practice.”
Attendee Moira Ogden, MD, hospitalist at Terrebonne General Medical Center in Houma, La., is interested in bringing ultrasound-guided procedures into her practice, although she fears access to the equipment may not be easy to obtain. “I want to start using them; I just need to know the cost,” she says.
“We’ve been at it for a year with our new hospitalist program,” Dr. Ogden said. “There’s such a difference between academic medicine and practice in the community. In my hospital, it’s very busy, although we’ve really just scratched the surface. It’s hard to keep up with the literature, and when I saw the flyer for this course, it looked so in-depth—almost like a re-introduction to hospital medicine.”
“Part of it was just plain curiosity—what is this going to be about? What do they see as blind spots for hospitalists in their day-to-day jobs?” asks Dr. Zachary, a six-year hospitalist, discussing his interest in attending the UCSF mini-college. “For the most part, my sense of the gaps has been dead-on.”