S2469 A Quality Improvement Study to Increase Diagnostic Paracentesis for Admitted Veterans With Ascites

Introduction: Multiple society guidelines recommend diagnostic paracentesis in all patients admitted to the hospital with cirrhosis and ascites. However, 1 multi-center study conducted at Veteran Administration (VA) medical centers demonstrated <15% of patients received early paracentesis (EP) within 24 h of initial presentation. The aim of this quality improvement (QI) study is to evaluate whether an educational intervention can improve the frequency of timely diagnostic paracentesis. Methods: This QI study was based on a 90-minute simulation-based educational session for all internal medicine trainees rotating at our VA inpatient service for each 3-week rotation started on January 13, 2025. The simulation utilized a mannequin and all the supplied necessary to perform a paracentesis at our facility. Furthermore, education regarding the indication for paracentesis was provided to all attendees. Outcomes were analyzed using statistical process control C chart of these data for both outcomes. Special cause variation was noted by the presence of a data point outside the upper control limit. Veterans were also divided into 2 cohorts, pre-intervention (October 2024 to December 2024) and post-intervention (January 2025 to April 2025). Results: One hundred thirty-two Veterans (96.8% man and median age 72 years) with liver cirrhosis were admitted from October 1, 2024 – April 14, 2025. Twenty-eight percent of the cohort (N = 37) had ascites present on admission. Amongst those with ascites, 20 (54%) and 14 (38%) Veterans had a diagnostic paracentesis at any point during their admission and EP, respectively. Special cause variation is noted in those undergoing diagnostic paracentesis after the educational intervention. A similar relationship was not observed for Veterans who received EP. There is no significant difference in proportion of paracentesis between the pre- and post- intervention cohorts. Conclusion: Early data from this QI study suggest that implementation of a structured educational simulation for internal medicine trainees increased the frequency of diagnostic paracentesis for Veterans with cirrhosis and ascites admitted to the hospital by means of special cause variation on a C chart. Aggregate comparisons of the pre and post intervention cohorts failed to show a statistically significant improvement, likely due to small sample size. Ongoing efforts aimed at both trainees and attending hospitalists are underway.