Introduction: At our institution, a lack of certified providers able to perform a bedside paracentesis has led to increased utilization of interventional radiology for both diagnostic and therapeutic paracenteses. With increased turnover of providers and low numbers of hospitalists able to perform the procedure, minimal supervision existed to train and certify new providers in paracenteses. Through a hospital initiative, a paracentesis team was formed, led by both hospitalists and certified residents, to increase the number of certified providers able to perform this procedure.
Methods: To pair providers together for training as well as to expedite patient care through timely paracenteses, an EPIC Chat Opt-In group was created in September 2021 titled “Medicine Paracentesis Priority List.” Any provider in the hospital could message the group requesting a paracentesis be completed. Providers in the chat could then offer to perform or to supervise another provider. Patient charts were saved for data collection. Requests to interventional radiology first were directed to the paracentesis team instead.
Results: Prior to the intervention, there were only 3 hospitalists and 3 certified residents available to supervise the procedure. Over the course of the 8 months, around 70 paracenteses were performed through chat request, and 10 new providers completed the minimum 5 paracentesis to become certified. A total of 30 different providers performed the procedure. Less than 10 needed to be referred to interventional radiology due to unsafe bedside paracentesis. There were 30 inpatient IR paracentesis in the 6 months prior to intervention, and 33 in the 6 months after start. However, March (month 7 after intervention) saw 0 paracenteses completed by IR, with only 5 in the past 3 months (months 5-7).
Discussion: The creation of a paracentesis team accessible through an EPIC Chat Opt-In group has increased certification of hospital providers and led to multiple beneficial outcomes for the hospital. Total numbers of Interventional Radiology paracenteses have stayed the same, followed by a sharp decrease over months 5-7, suggesting a lag period. Additional outcomes were centralized collection of paracentesis materials and standardized policies for performing the procedure and escalating care to IR. With our hospital support and continued growth of certified providers, we expect this intervention to lead to improved hospital outcomes and many more certified providers.
