Optimizing Large-Volume Paracentesis in a Gastroenterology Ward: A Two-Cycle Quality Improvement Project

Background In a busy gastroenterology ward in a London district general hospital, delays were frequently encountered when preparing large-volume paracentesis, mainly due to difficulties in locating and gathering equipment. This Quality Improvement Project (QIP) aimed to standardize equipment preparation, improve perceived efficiency, and enhance post-procedure documentation. Methodology A resident doctor-led, two-cycle QIP was conducted using the Plan-Do-Study-Act (PDSA) methodology. Cycle one focused on equipment preparation. Baseline data were collected via surveys, followed by the introduction of a standardized equipment checklist poster displayed at the doctors' office. Self-reported time taken to locate and gather equipment was collected pre- and post-intervention. Cycle two focused on post-procedure documentation through the development of a smart text proforma within the electronic patient record to promote safe and consistent documentation. Self-reported time taken for documentation and user feedback was collected. Results There were nine respondents before and six after the poster intervention in cycle one, while in cycle two, there were eight respondents before and six after the introduction of the smart text proforma. At baseline, over half of the resident doctors (five out of nine) required 6-10 minutes to prepare equipment, and 78% (seven out of nine) reported incomplete knowledge of required items. Following the poster intervention, all six respondents had seen the poster, and 83% (five out of six) felt it reduced preparation time. In cycle two, baseline data showed that 50% (four out of eight) required guidance for documentation, with 38% (three out of eight) spending four to six minutes and 25% (two out of eight) spending over 10 minutes per note. After introducing the proforma, all six respondents found it helpful and anticipated being able to complete documentation independently. Overall, 50% (three out of six) and 33% (two out of six) anticipated spending one to three minutes and four to six minutes per note, respectively. Qualitative feedback highlighted clearer and faster documentation. Conclusions Overall, the standardized equipment checklist and smart text proforma were perceived to reduce procedural delays and were reported to improve documentation consistency. They also improved trainee confidence and reduced uncertainty. Similar approaches could be applied to other departments and procedures, with local refinement to ensure ongoing accuracy and relevance.