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Quality improvement initiative increases total paracentesis and early paracentesis rates in hospitalised cirrhotics with ascites
  1. Arun Jesudian1,
  2. Luis Barraza2,
  3. Peter Steel3,
  4. Nicole Shen1,
  5. Yecheskel Schneider4,
  6. David Bodnar3,
  7. Brenna Farmer3,
  8. Savira Dargar5,
  9. Cristina Del Toro3,
  10. Rahul Sharma3,
  11. Robert S Brown, Jr.1,
  12. Jennifer Inhae Lee5
  1. 1 Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
  2. 2 Division of Digestive and Liver Diseases, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  3. 3 Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
  4. 4 Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  5. 5 Department of Medicine, Weill Cornell Medicine, New York, New York, USA
  1. Correspondence to Dr Arun Jesudian,Gastroenterology and Hepatology, Weill Cornell Medicine, New York, USA; abj9004{at}


Objective Early paracentesis (EP) for rapid diagnosis of spontaneous bacterial peritonitis is considered best practice in the care of admitted patients with cirrhosis and ascites, but inpatient paracentesis is frequently not performed or delayed. We developed a quality improvement (QI) initiative aimed at increasing the proportion of admitted patients with cirrhosis who undergo paracentesis and EP.

Design Pre–post study of a QI initiative.

Setting A tertiary care hospital in a major metropolitan area.

Patients Hospitalised patients with cirrhosis and ascites.

Interventions We targeted care providers in the emergency department (ED) by raising awareness of the importance of EP, developing criteria to identify patients at highest risk of SBP who were prioritised for EP by ED providers and restructuring the ED environment to enable timely paracentesis.

Results 76 patients meeting inclusion criteria were admitted during the postintervention 9-month study period. Of these, 91% (69/76) underwent paracentesis during admission versus 71 % (77/109) preintervention (p=0.001). 81% (56/69) underwent EP within 12 hours of presentation or after a predefined acceptable reason for delay versus 48% (37/77) preintervention (p=0.001). There were no significant differences in in-hospital mortality or length of stay before and after intervention.

Conclusion A multidisciplinary QI intervention targeting care in the ED successfully increased the proportion of patients with cirrhosis and ascites undergoing diagnostic paracentesis during admission and EP within 12 hours of presentation.

  • ascites
  • liver cirrhosis

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  • Contributors AJ is responsible for the overall content as guarantor and contributed to the drafting of the manuscript. LB, NS, SD and YS contributed to the statistical analysis. RS, RSB and JIL contributed to the study supervision. All authors contributed to the study concept and design, acquisition of data; analysis and interpretation of data and critical revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Weill Cornell Medicine Institutional Review Board approved the study protocol (no. 1512016841).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.