Standardizing Ascitic Fluid Panel to Improve Outcomes in a Large State Hospital

Abstract

Purpose: The purpose of this quality improvement project was to increase provider compliance with evidence-based, hepatology-recommended ascitic fluid studies among inpatient providers from a baseline of 50% to 60% within five months through electronic health record (EHR) standardization. Background: Delayed or incomplete ascitic fluid analysis can increase the risk of preventable complications. Workflow variability and non-standardized ordering practices contributed to inconsistent adherence to evidence-based recommendations. Methodology: Using the Institute for Healthcare Improvement (IHI) Model for Improvement with Plan–Do–Study–Act (PDSA) cycles, two paracentesis workflows were redesigned. For the Mobile Procedure Team, a standardized ascitic fluid panel with six defaulted, evidence-based tests was embedded into the workflow. Due to technical limitations within the Interventional Radiology (IR) EHR build, a standalone panel was created to support the IR workflow. Compliance was evaluated through retrospective chart review with pre–post comparison using descriptive statistics. A Likert-scale survey assessed provider awareness and perceived workflow efficiency. Results: IR compliance increased to 80%, and Mobile Procedure Team compliance increased to 97.5%. Adherence was higher when the panel was directly embedded in the workflow. Eighty-five percent of providers reported awareness of the updated workflows and improved efficiency. Implications: Embedding standardized, evidence-based testing into EHR workflows reduced practice variation and improved adherence to specialty recommendations. This low-cost redesign demonstrates how targeted EHR optimization can enhance diagnostic efficiency and may be scalable to other procedural workflows.

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