Clinical research studyClinical Outcomes after Bedside and Interventional Radiology Paracentesis Procedures
Section snippets
Design
We performed an observational medical records review of all paracentesis procedures performed on the hepatology service at Northwestern Memorial Hospital, an 894-bed urban tertiary care hospital, from July 2008 through December 2011. The hepatology service is staffed by an internal medicine second- or third-year resident, 2 or 3 first-year residents, a gastroenterology fellow, and a supervising attending physician from the Section of Hepatology at Northwestern University Feinberg School of
Results
The EDW search and chart adjudication identified 806 paracentesis procedures performed on 614 patients. A final sample of 622 procedures from 502 patients remained after removing procedures due to exclusion criteria (Figure 1).
Discussion
To our knowledge, this is the first study to address clinical decision-making about performance of paracentesis procedures at the bedside or in IR. Our findings show that our overall ability to predict decision-making on the basis of patient characteristics is poor. Specifically, decisions about procedure location are not aligned closely with known predictors of morbidity and mortality in patients with liver disease (eg, age, sex, systolic blood pressure, serum sodium, platelet count, and MELD
Conclusions
In summary, this study shows that the decision to perform a paracentesis at the bedside or in IR is largely discretionary and rarely based on patient characteristics. Paracentesis procedures performed at the bedside result in equivalent or better patient outcomes, and increasing the number of bedside procedures could result in significant cost savings. Based on these findings, we recommend that residents and other clinicians continue to receive the education and training necessary to perform
Acknowledgements
We acknowledge Drs Douglas Vaughan and Mark Williams for their support and encouragement of this work. We thank Darlene Ferranti for her assistance with the Enterprise Data Warehouse.
References (30)
- et al.
Diagnosis and epidemiology of cirrhosis
Med Clin North Am
(2009) - et al.
A model to predict survival in patients with end-stage liver disease
Hepatology
(2001) - et al.
Model for end-stage liver disease (MELD) and allocation of donor livers
Gastroenterology
(2003) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
J Clin Epidemiol
(1992) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives
J Clin Epidemiol
(1993) - et al.
Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies
J Hepatol
(2006) - et al.
National fluid shifts: fifteen-year trends in paracentesis and thoracentesis procedures
J Am Coll Radiol
(2010) - et al.
Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study
Chest
(2008) Chronic liver disease or cirrhosis
- et al.
Management of cirrhosis and ascites
N Engl J Med
(2004)
EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis
J Hepatol
Management of adult patients with ascites due to cirrhosis: an update
Hepatology
The declining number and variety of procedures done by general internists: a resurvey of members of the American College of Physicians
Ann Intern Med
What procedures should internists do?
Ann Intern Med
Procedures performed by hospitalist and non-hospitalist general internists
J Gen Intern Med
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Funding: Excellence in Academic Medicine Act of the Illinois Department of Public Aid administered by Northwestern Memorial Hospital. Dr. McGaghie's contribution was supported in part by the Jacob R. Suker, MD professorship in medical education and by grant UL 1 RR 025741 from the National Center for Research Resources, National Institutes of Health (NIH). The funding source had no role in the preparation, review, or approval of the manuscript.
Conflict of Interest: None.
Authorship: All authors were involved in the conception and design of the study or analysis of data, participated in the writing of the manuscript, and have seen and approved the submitted version.