SHM Converge Scientific Abstract ePoster Gallery-Impact of a Hospitalist-Run Medical Procedure Service in a Dedicated Paracentesis Clinic Compared to Emergency Room Admissions.

Impact of a Hospitalist-Run Medical Procedure Service in a Dedicated Paracentesis Clinic Compared to Emergency Room Admissions.

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This retrospective study evaluated a hospitalist-run outpatient palliative paracentesis clinic at Stroger Hospital of Cook County, an urban safety-net hospital, from March 2020 to November 2021. The goal was to assess whether a dedicated outpatient clinic could reduce healthcare utilization and lower costs compared with hospital-based care for patients with ascites.<br /><br />The clinic saw 40 patients across 491 paracentesis encounters. Patients were mostly male (75%), middle-aged (average age 56.2 years), and predominantly Hispanic (74.4%). Alcoholic cirrhosis was the most common cause of ascites (62.5%). Most patients required frequent procedures, typically every two weeks, and the average volume removed was 7.6 liters per procedure.<br /><br />Safety outcomes were favorable. There were no cases of hypotension, major bleeding, or intraabdominal perforation/infection. Very few complications occurred: emergency department visits happened in 6 per 1,000 encounters, and ascitic leak or cellulitis requiring care occurred in 2 per 1,000 encounters.<br /><br />The clinic also appeared to reduce costs substantially. Estimated total costs for outpatient management ranged from about $408,941 to $441,307, compared with $3,121,778 to $3,614,742 for observation/inpatient care. This suggests potential savings of approximately $2.68 million to $3.21 million.<br /><br />In terms of longer-term outcomes, 26.7% of patients had resolution of ascites, 33.3% died from complications such as sepsis or liver failure, 13.3% enrolled in hospice, and 26.7% were lost to follow-up. Overall, the study concludes that a dedicated outpatient paracentesis clinic can safely manage patients with frequent ascites, reduce high-acuity hospital use, and generate major cost savings for healthcare systems.

Asset Subtitle

Umair Jabbar

Meta Tag

Author List Nigist Taddese, Umair Jabbar

Category Research

Concept Cirrhotic Ascites

Concept Paracentesis

Concept Outpatient Clinic

Concept Healthcare Cost

Concept Large-Volume Paracentesis

Distinguished Non-Finalist

Presenter Organization Cook County Health

Presenting Author Umair Jabbar

Track Value in Hospital Medicine

Keywords

outpatient palliative paracentesis

ascites

hospitalist-run clinic

safety-net hospital

healthcare utilization

cost savings

cirrhosis

alcoholic cirrhosis

paracentesis complications

hospice

Cirrhotic Ascites

Paracentesis

Outpatient Clinic

Healthcare Cost

Large-Volume Paracentesis