{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T22:52:19Z","timestamp":1771023139640,"version":"3.50.1"},"reference-count":25,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Frontline Gastroenterol"],"accepted":{"date-parts":[[2019,4,12]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Early paracentesis (EP) for rapid diagnosis of spontaneous bacterial peritonitis is considered best practice in the care of admitted patients with cirrhosis and ascites, but inpatient paracentesis is frequently not performed or delayed. We developed a quality improvement (QI) initiative aimed at increasing the proportion of admitted patients with cirrhosis who undergo paracentesis and EP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design\u00a0<\/jats:title>\n                  <jats:p>Pre\u2013post study of a QI initiative.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting\u00a0<\/jats:title>\n                  <jats:p>A tertiary care hospital in a major metropolitan area.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients\u00a0<\/jats:title>\n                  <jats:p>Hospitalised patients with cirrhosis and ascites.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>We targeted care providers in the emergency department (ED) by raising awareness of the importance of EP, developing criteria to identify patients at highest risk of SBP who were prioritised for EP by ED providers and restructuring the ED environment to enable timely paracentesis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>76 patients meeting inclusion criteria were admitted during the postintervention 9-month study period. Of these, 91% (69\/76) underwent paracentesis during admission versus 71 % (77\/109) preintervention (p=0.001). 81% (56\/69) underwent EP within 12\u2009hours of presentation or after a predefined acceptable reason for delay versus 48% (37\/77) preintervention (p=0.001). There were no significant differences in in-hospital mortality or length of stay before and after intervention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>A multidisciplinary QI intervention targeting care in the ED successfully increased the proportion of patients with cirrhosis and ascites undergoing diagnostic paracentesis during admission and EP within 12\u2009hours of presentation.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/flgastro-2019-101199","type":"journal-article","created":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T19:27:08Z","timestamp":1556566028000},"page":"22-27","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Quality improvement initiative increases total paracentesis and early paracentesis rates in hospitalised cirrhotics with ascites"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8562-3375","authenticated-orcid":false,"given":"Arun","family":"Jesudian","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Barraza","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Steel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Shen","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yecheskel","family":"Schneider","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Bodnar","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenna","family":"Farmer","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savira","family":"Dargar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Del Toro","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S","family":"Brown, Jr.","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer Inhae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,29]]},"reference":[{"key":"2025090708572317000_11.1.22.1","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1038\/ajg.2011.314","article-title":"Hospital readmissions among patients with decompensated cirrhosis","volume":"107","author":"Volk","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"2025090708572317000_11.1.22.2","doi-asserted-by":"crossref","DOI":"10.1038\/ctg.2016.25","article-title":"Quality of care in the cirrhotic patient","volume":"7","author":"Volk","year":"2016","journal-title":"Clin Transl Gastroenterol"},{"key":"2025090708572317000_11.1.22.3","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.1007\/s10620-018-4990-y","article-title":"Mortality from spontaneous bacterial peritonitis among hospitalized patients in the USA","volume":"63","author":"Niu","year":"2018","journal-title":"Dig Dis Sci"},{"key":"2025090708572317000_11.1.22.4","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/S0168-8278(00)80201-9","article-title":"Diagnosis, treatment and prophylaxis of spontaneous bacterial peritonitis: a consensus document. 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