Background: In caring for hospitalized patients, hospitalists frequently perform bedside procedures. Shared decision-making, fluency in the procedure being performed, and consistent use of best practices are imperative for high quality, safe patient care. In review of bedside paracentesis between 8/2017–4/2018 by hospitalist fellows in conjunction with attending physicians and resident physicians, variations in procedure technique, materials used, documentation, and consenting process have been identified.
Purpose: Develop and implement a standardized consent form to be given to the patient for review prior to seeing the physician, and implement a pre-procedure checklist for paracentesis based upon best practices.
Description: Literature on society-based recommendations regarding paracentesis technique, indications, contraindications, and complications were reviewed in detail. Internal expert opinions from hospitalists, interventional radiologists, gastroenterologists, and risk management were solicited and shared to arrive at consensus. A pre-procedure paracentesis checklist (Figure 1). was then developed for multidisciplinary use. Additionally, ten patients scheduled for paracentesis were interviewed regarding their understanding of steps involved in the procedure, associated risks, and potential benefits. Of these, 100% knew what the procedure was and why it was beneficial, but only 20% were able to identify at least two potential complications. Thirty percent felt that the procedure was not explained well, and 20% felt that they could not decline the procedure. On average, physician time spent on consent varied from 40 seconds to 5 minutes. Subsequently, a consent form in patient-friendly language with images (Figure 2) was created to ensure that details of the procedure, along with its indications, risks, and benefits would be accessible to patients. Its use also intends to limit variations in the time and information provided at bedside. The next step will be to provide education on best practice performance guidelines for paracentesis using both the pre-procedure checklist along with the standardized consent form. Implementation of these innovations will be piloted by the hospital medicine team after which organizational adoption is anticipated.
Conclusions: A pre-procedure checklist for bedside paracentesis has been developed to achieve uniformity in practice and to promote highest quality care. Additionally, shared decision-making among patients and their caregivers will be supported by the implementation of a standardized consent document.
To cite this abstract:Thomas, SM; Geyer, CK; Mueller, Z; Dickens, JD; Stanhiser, D; Friedel, G. STANDARDIZATION OF BEDSIDE PARACENTESIS. Abstract published at Hospital Medicine 2019, March 24-27, National Harbor, Md. Abstract 234. https://www.shmabstracts.com/abstract/standardization-of-bedside-paracentesis/. Accessed December 6, 2019.