S1055 Decreased Time to Diagnostic Paracentesis in the Hospitalized Internal Medicine Patient

Abstract

INTRODUCTION: Early diagnostic paracentesis decreases mortality, length of stay, readmission rates and cost of hospitalization. We sought to decrease the time to initial diagnostic paracentesis to below 24 hours at our institution over three months. METHODS: We reviewed data from medicine admissions at our hospital between September 2018 and September 2019. Any patient admitted with ascites was included. Interventions included education for internal medicine residents and faculty, a knowledge and barrier survey, a diagnostic paracentesis checklist and kit for efficiency, and education for emergency department providers with a proposed decision algorithm. Our intervention implementation date was December 1st, 2019. We collected post-intervention data from December 2019 through February 2020. RESULTS: Our pre-intervention average time to paracentesis was 37.8 hours. Spontaneous bacterial peritonitis (SBP) was diagnosed in 16.6% of pre-intervention cases. The post-intervention average time from December to February was 21.6, 32.4 and 17.3 hours for each respective month with a total average of 24.3 hours for the three-month period. There was a total of 79 paracenteses completed and 9 cases of SBP (11.4%). Pre-intervention, the emergency department (ED) completed 20.4% of the paracenteses with a 9.2 hour average which improved to 34.2% at 7.3 hours post-intervention. The primary medicine team improved from 33.6 hour to 27.1 hour with completion of 26.6% of the cases. The medicine procedure team improved from 47.8 hour to 38.5 hour with completion of 10.1% of the cases. Interventional radiology improved from 51.6 hour to 36.8 hour with 29.1% of the cases. CONCLUSION: We were close to achieving our targeted goal of time to diagnostic paracentesis for the hospitalized internal medicine patients by decreasing the time to diagnostic paracentesis from 37.8 to 24.3 hours. This effectively decreased the time by 13.5 hours for patients on average. Each specialty involved improved on their average time with our interventions. The ED performed more paracenteses in the post-intervention period, taking some burden off of the internal medicine physicians. We project that because the patients we collected data on were admitted to the hospital, this effectively decreased their length of stay by at least half a day which is considered a positive return on investment for the hospital. Further investigation is required to determine the other benefits of improving the time to paracentesis in our institution.Image 1.: Weekly average time to diagnotic paracentesis from pre-intervention time through post-intervention time.Image 2.: Number of paracenteses completed by department in post-intervention data.