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- W2978906873 abstract "Introduction: Spontaneous bacterial peritonitis (SBP) is a frequent and life-threatening infection of the peritoneal fluid. Early paracentesis can detect an unexpected infection at an incidence of 12%. This can lead to prompt recognition and early treatment of SBP. In this study, we re-evaluated our hospitals adherence to current guidelines for SBP management after implementing several measures of intervention. Methods: In 2013, we conducted a retrospective chart review of cirrhotic patients with ascites, while simultaneously conducting a survey of internal medicine residents to evaluate for knowledge of SBP management (Group 1). After the study, we engineered a paracentesis order set in our EMR and educated residents to improve adherence to guidelines at our hospital. Subsequently, we conducted another retrospective chart review with the same survey in 2015 (Group 2) and performed a head to head comparison. Results: Over 200 patient charts were reviewed in each group. 70 patients met inclusion criteria (ascites from liver cirrhosis) in Group 1 vs 52 in Group 2. In Group 1, 43% had a paracentesis compared to 67% in Group 2. Prompt paracentesis were performed in 42% of patients in Group 1 compared to 49% in Group 2. SBP was diagnosed in 13.3% of patients in Group 1 with 0 positive cultures vs 11.4% in Group 2 with 2 positive cultures. Nearly all ascetic fluid were sent for cell count in both groups; however Group 2 performed better in ordering appropriate testing for protein and albumin levels in addition to fluid culture. Group 2 ordered fewer non-cost effective tests: LDH, glucose, amylase and triglycerides. Both groups collected cultures correctly in blood culture bottles 28% (Group 1) vs 24% (Group 2) of the time. Survey results showed that residents in Group 2 had better knowledge of paracentesis technique, periprocedure sample collection and SBP diagnostic criteria. The majority of the patients received antibiotics before a tap in both groups. Conclusion: After implementing several measures discussed above, the residents showed improvement in knowledge about paracentesis technique, peri-procedure sample collection and appropriate testing of ascitic fluid. However, continued improvement is needed for appropriate culture collection, prompt paracentesis, and minimizing antibiotic use prior to paracentesis. We propose that continued education and implementation of a training session in our simulation lab regarding paracentesis technique would improve adherence to current guidelines.Figure 1Figure 2" @default.
- W2978906873 created "2019-10-10" @default.
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- W2978906873 date "2015-10-01" @default.
- W2978906873 modified "2023-09-25" @default.
- W2978906873 title "Review of Ascites and Spontaneous Bacterial Peritonitis Diagnosis and Treatment in Cirrhotic Patients at Mount Sinai St. Lukes Roosevelt Hospital: A Follow-Up" @default.
- W2978906873 doi "https://doi.org/10.14309/00000434-201510001-02161" @default.
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