Towards patient-centred and cost-effective care for patients with cirrhosis and ascites

Thomson, Mary; Tapper, Elliot B.

doi:10.1016/s2468-1253(17)30339-4

Cited by 2 publications

(1 citation statement)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, these interventions are less accessible to low income populations in the U.S. 2 Consequently, uninsured or underinsured patients with refractory ascites continue to place significant demand on the emergency department (ED) and inpatient hospital setting to perform paracentesis. 3 Although outpatient clinics have been increasingly established to perform paracentesis 4 – 7 , these services have frequently been delivered by interventional radiologists 8 and may not be available in safety net institutions caring for low-income populations.…”

Section: Introductionmentioning

confidence: 99%

Transitioning from the Emergency Department to a General Internist Outpatient Clinic for Paracentesis: A Qualitative

Koh,

Dowlatshahi,

Turner

2023

Preprint

View full text Add to dashboard Cite

Background Repeated paracentesis for ascites can place significant demands on the emergency department (ED). A new general internist-led outpatient procedure clinic to alleviate this demand required ED staff and patients to accept this transition of care. Aim: This qualitative study evaluates barriers and facilitators to implementing the FLuid ASPiration (FLASP) clinic in a safety net hospital. Methods The FLASP clinic opened during the COVID-19 pandemic in March 2021. From February to April 2022, semi-structured interviews were conducted with: 10 ED physicians and nurses; 5 FLASP clinic patients; and 4 patients receiving paracentesis in the ED. Interviews were recorded, transcribed, and analyzed using a Grounded Theory approach for themes categorized by Theory of Planned Behavior (TPB) domains including: attitudes/knowledge; social norms; and logistics. Results Thematic analysis found that ED staff appreciated reduced demand for paracentesis, but barriers included: lack of knowledge; concerns about unstable patients and patient expectations (norms); and scheduling logistics. FLASP clinic patients had only favorable themes: belief in clinic safety; positive relationship with staff; and clinic efficiency. Patients using the ED for paracentesis expressed only concerns: possible need for testing or hospitalization; care usually in the ED; and unclear clinic scheduling. Conclusion This study reveals challenges to transitioning sites of care for paracentesis including the need for greater ED staff education and standardizing methods to triage patients to appropriate site of care. Greater support and education of ED patients about the benefits of an outpatient procedure clinic may also reduce ED burden for paracentesis.

show abstract