Optimizing care for patients who have ascites: shifting paracentesis from the emergency department to outpatient medicine

We would like to address the current care pathways for patients requiring paracentesis for ascites and highlight opportunities to improve and streamline their management.Herein, we report a retrospective study in the Emergency Department (ED) of Hpital Montfort, Ottawa, Ontario conducted between April 2022 and April 2024, concluding most paracenteses performed in the ED could likely have been safely scheduled and performed in an outpatient setting, thereby improving patient experience while reducing strain on hospital resources.The study received a compliance letter from the Hpital Montfort Research Ethics Board.Among the 32 patients included (46 visits), 75% had a known history of cirrhosis, and 78% had access to a primary care provider.Despite this, 60% of visits involved patients with a prior history of paracentesis, and nearly two-thirds of presentations resulted in hospital admission.Twenty-six of the 46 visits (57%) were single visits, while the remainder were recurrences, including one patient with seven visits.Thus, 43% of paracenteses were performed in six patients.Almost half of the visits occurred outside regular clinic hours, suggesting that patients lacked alternative access points for timely evaluation and management of symptomatic ascites.These findings informed the development of criteria to identify patients who may be appropriate candidates for scheduled outpatient paracentesis.The key determinants include hemodynamic stability, absence of clinical suspicion for spontaneous bacterial peritonitis, and a well-established diagnosis of chronic ascites.We also proposed criteria for recognizing potentially avoidable ED visits, such as *