{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T13:01:54Z","timestamp":1790427714211,"version":"4.1.0"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ascites is a common and debilitating complication of decompensated cirrhosis that frequently requires therapeutic paracentesis (TP) for symptom relief. Limited outpatient procedural capacity may contribute to avoidable hospital readmissions. The use of registered nurses (RNs) to perform TP remains uncommon, with few models described internationally.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the safety of an RN\u2010led outpatient TP model and describe the potential geographic reach of patients accessing care at a Canadian tertiary liver clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective chart review was conducted of all outpatient TP procedures performed at Toronto General Hospital between 6 June 2022 and 28 February 2023. Procedures were performed either in the Medical Day Unit (MDU; performed by physicians\/nurse practitioners) or in the Liver Clinic (LC) procedure room by trained RNs. The primary outcome was the occurrence of predefined procedure\u2010related adverse events. Adverse events were identified through review of clinical documentation, including emergency department visits within the institutional health network and patient\u2010reported events documented in the electronic medical record. A secondary analysis examined geographic patterns of access using patient residential postal codes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 124 patients underwent 580 TP procedures, of which 55.2% were performed by RNs. Alcohol\u2010associated liver disease and metabolic dysfunction\u2010associated steatotic liver disease were the most common underlying etiologies. No procedure\u2010related complications were identified (0%; 95% CI: 0\u20130.52%). Most patients resided within the Greater Toronto Area; however, some travelled up to 360\u2009km, often bypassing closer hospitals, to access outpatient services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An RN\u2013led outpatient TP model demonstrated reassuring safety signals and contributed to expanded procedural capacity within an ambulatory liver programme. These findings support the feasibility of nurse\u2010led procedural models as a strategy to improve access to care for patients with decompensated cirrhosis. Further evaluation is needed to assess the impact of this approach on healthcare utilisation and patient\u2010reported outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70578","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:55:20Z","timestamp":1788893720000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of a Registered Nurse\u2010Led Outpatient Paracentesis Service for Decompensated Cirrhosis: A Retrospective Review"],"prefix":"10.1111","volume":"32","author":[{"given":"Molly","family":"McDonald","sequence":"first","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Fang","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Song","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colina","family":"Yim","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pam","family":"Hubley","sequence":"additional","affiliation":[{"name":"Collaborative Academic Practice University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8690-7227","authenticated-orcid":false,"given":"Ina","family":"Cherepaha\u2010Kantorovich","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharlene","family":"Camaya","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3118-7835","authenticated-orcid":false,"given":"Elizabeth","family":"Lee","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver Disease, Toronto General Hospital University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/apt.16488"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32032"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3138\/canlivj-2022-0033"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2019.03.016"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v23.i37.6868"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2021-101850"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32378"},{"key":"e_1_2_9_9_1","unstructured":"S.VermaDiagnostic and Large\u2010Volume Abdominal Paracentesis \u2013 UpToDate accessed April 13 2026 https:\/\/www.uptodate.com\/contents\/diagnostic-and-large-volume-abdominal-paracentesis\/print."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000530"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.314"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1141"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-33851-9_45"},{"key":"e_1_2_9_15_1","unstructured":"College of Nurses of Ontario.Scope of Practice. 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