The acceptability of a novel procedure service run by PAs and NPs.

BACKGROUND: Hospitalist physicians are performing fewer procedures because of multiple reasons, including expanded responsibilities beyond their patient panel. A procedure service that offloads hospitalists could expedite these necessary services. An opportunity exists for physician assistants (PAs) and NPs to fill this gap. OBJECTIVE: To describe the implementation of a PA- and NP-run procedure service at a large academic hospital. METHODS: This is a retrospective cohort study of procedures by the procedure service at one institution from 2015 to 2019. RESULTS: Over 5 years, 7,002 procedures were performed, with requests increasing over time. The most frequent procedures were venous access, lumbar puncture, paracentesis, and placement of nasogastric or nasojejunal tubes. Requesting services included hospitalists and residents from internal medicine, surgery, and neurology. CONCLUSIONS: A PA- and NP-run procedure service is well accepted at a large academic hospital despite the lack of involvement by attending physicians. Future directions are focused on augmenting coverage and procedures offered.

The role of percutaneous coronary intervention in managing patients with stable ischemic heart disease.

A major outcome of cardiology research over the last 2 decades is the finding that intensive medical management of patients with stable ischemic heart disease is as effective as revascularization procedures in preventing cardiac events and death. This finding has generated management guidelines that often are overlooked because of misplaced enthusiasm for revascularization procedures.