Sa1373: IMPACT OF AN OUTPATIENT PARACENTESIS CLINIC ON EMERGENCY DEPARTMENT UTILIZATION AT A METROPOLITAN SAFETY NET HOSPITAL

Angajala, Varun; Vyas, Annasha; Koh, Jennifer; Shahrestani, Shane; Dowlatshahi, Shadi

doi:10.1016/s0016-5085(22)63432-2

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“…In a quantitative analysis, we reported that the FLASP clinic was associated with reduced demand for paracentesis in the ED. 16 Lastly, Maintenance of the FLASP clinic ( Fig. 1 ) was not specifically addressed by this qualitative study but patients and ED providers expressed satisfaction with the FLASP clinic, supporting the value of continuing this new service.…”

Section: Discussionmentioning

confidence: 78%

“…Implementation of novel health care delivery settings requires not only complex training of providers and staff 16 but also behavioral changes by patients and referring providers to understand, accept, and utilize an alternative to the current pattern of care. 17 This qualitative study used Ajzen’s Theory of Planned Behavior as a conceptual model 9 to categorize facilitators and barriers to transitioning care for patients with refractory ascites from the ED to the FLASP procedural clinic.…”

Section: Discussionmentioning

confidence: 99%

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

Koh,

Dowlatshahi,

Turner

2023

Preprint

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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.

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Section: Discussionmentioning

confidence: 78%