Quality improvement initiative increases total paracentesis and early paracentesis rates in hospitalised cirrhotics with ascites.
Frontline Gastroenterol
; 11(1): 22-27, 2020 Jan.
Article
em En
| MEDLINE
| ID: mdl-31885836
ABSTRACT
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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Guideline
/
Prognostic_studies
Idioma:
En
Revista:
Frontline Gastroenterol
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Estados Unidos