Who is doing the tap? A multicentre audit and trainee survey exploring barriers to performing diagnostic paracentesis

Objective Spontaneous bacterial peritonitis is a serious complication of liver cirrhosis and diagnostic delay is associated with increased mortality. National guidance recommends diagnostic paracentesis within 6 hours of presentation. We hypothesised that inadequate training and awareness among admitting clinicians contribute to this target not being met and designed a study to assess potential factors underlying procedure delay. Method A two-part multicentre study was conducted: (1) a survey assessing doctors’ knowledge, confidence and attitudes towards diagnostic paracentesis across four UK hospitals; (2) a retrospective audit across seven UK hospitals in which time to paracentesis was benchmarked against national guidance. Associations between delay, outcomes and systemic factors were assessed using SPSS V.30 and RStudio V.4.5.0. Results Of 105 doctors responding to the survey, 100% of foundation year 1 doctors and 78.6% of senior house officers lacked confidence to perform a tap independently as did 20% of specialist registrars. In a hypothetical clinical scenario, only 51.4% would perform a tap; 25.7% were deterred by coagulopathy and 21.9% cited lack of confidence. 207 patients were admitted with cirrhosis and ascites. Median time to paracentesis was 10 hours 51 min and no centre met the 6 hours standard. Delays in paracentesis correlated with longer waits for clerking, antibiotic administration and specialist review (p<0.05). Conclusions Lack of confidence, knowledge and systemic delays were key barriers to timely diagnostic paracentesis. Targeted training and education may improve care for patients with decompensated cirrhosis and ascites.