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Abstract
Objective Using quality improvement techniques, we aimed to improve the rate of assessment and sampling of ascitic fluid for the purpose of diagnosing spontaneous bacterial peritonitis in patients with cirrhosis admitted to the hospitalist service of our institution.
Design/methods Based on stakeholder needs assessment, we implemented interventions targeting provider knowledge, procedure workflows and clinical decision support. We analysed key metrics during preintervention (September–December 2020), intervention roll-out (January–April 2021), postintervention (May–September 2021) and sustainability (September–December 2022) periods for admissions of patients with cirrhosis to our hospitalist service at Maine Medical Center, a 700-bed tertiary-care academic hospital in Portland, Maine, USA.
Results Among patients with cirrhosis admitted to our service, documentation of assessment for paracentesis increased from a preintervention baseline of 60.1% to 93.5% (p<0.005) postintervention. For patients with ascites potentially amenable to paracentesis, diagnostic paracentesis rate increased from 59.7% to 93% (p<0.005), with the rate of paracentesis within 24 hours increasing from 52.6% to 77.2% (p=0.01). These improvements persisted during our sustainability period. Complication rate was low (1.2%) across all study periods.
Conclusion Our quality improvement project led to a sustained improvement in the identification of patients with cirrhosis needing diagnostic paracentesis and an increased procedure completion rate. This improvement strategy serves as a model for needed work toward closing a national performance gap for patients with cirrhosis.
- CIRRHOSIS
- PERITONITIS
Data availability statement
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Data availability statement
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Footnotes
Twitter @LizHerrle
Contributors Project idea generated by LBG. LBG, MT, MSB and ELH collaborated on the overall design of the quality improvement project with JP, VM and NC providing specific insight into the needs of resident physicians. All study authors contributed to implementation of QI interventions, chart review and manuscript preparation. ELH was primarily responsible for data analysis. ELH and LBG are the guarantors of the article.
Funding This study was supported by a grant from The Society to Improve Diagnosis in Medicine (SIDM) with funding from the Grant and Betty Moore Foundation (Grant #16001950101). Representatives of (SIDM) provided mentorship in project development.
Disclaimer The goals of the project, data extraction and review, interpretation of the data and decision to publish were done solely by the study authors without involvement by the funding sources.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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