Quality improvement initiative increases total paracentesis and early paracentesis rates in hospitalised cirrhotics with ascites.
ascites
liver cirrhosis
Journal
Frontline gastroenterology
ISSN: 2041-4137
Titre abrégé: Frontline Gastroenterol
Pays: England
ID NLM: 101528589
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
08
02
2019
revised:
27
03
2019
accepted:
12
04
2019
entrez:
31
12
2019
pubmed:
31
12
2019
medline:
31
12
2019
Statut:
ppublish
Résumé
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. Pre-post study of a QI initiative. A tertiary care hospital in a major metropolitan area. Hospitalised patients with cirrhosis and ascites. 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. 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. 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.
Identifiants
pubmed: 31885836
doi: 10.1136/flgastro-2019-101199
pii: flgastro-2019-101199
pmc: PMC6914287
doi:
Types de publication
Journal Article
Langues
eng
Pagination
22-27Informations de copyright
© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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