Improving the quality of paracentesis practices in people with advanced cirrhosis in an ambulatory care setting
Bibliographic record
Abstract
Abstract Background and Aims Spontaneous bacterial peritonitis (SBP) is a lethal complication of decompensated cirrhosis with a 90% mortality rate if untreated. Despite AASLD guidelines, a practice gap exists in fluid cell count (FCC) collection during paracentesis. We initiated a quality improvement (QI) project to increase FCC collection from 78% to 100% in an ambulatory setting between September 11, 2022, and April 17, 2023. Methods We evaluated 233 ambulatory patient encounters for paracentesis procedures at a quaternary care centre in Toronto. A multidisciplinary QI initiative included focused groups, AASLD guideline education, a paracentesis bundle, and workflow streamlining. Descriptive statistics and statistical analyses using run charts and p-charts were conducted via QI Macros. Institutional QI Review Committee approval was obtained. Results Baseline FCC adherence was 78%. Process mapping identified inconsistencies in documentation, label printing, and FCC collection. Bedside paracentesis bundles were introduced, increasing FCC collection marginally to 79.6% with no special cause variation. Subgroup analysis showed FCC collection rates of 100% among RNs/NPs, 97% among residents, and 92% among attending physicians. General hepatology had a 97% collection rate, while specialty hepatology had 40%. The SBP rate was 1.62% (N = 3). Discussion This study highlights a persistent gap in FCC collection during ambulatory paracentesis. Understanding reasons for non-compliance and assessing the FCC collection’s impact on morbidity and mortality in ambulatory settings are next crucial steps to optimize care for this high-risk population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".