Early Experiences in Establishing a Palliative Care-Integrated Paracentesis Clinic

Recurrent ascites is a debilitating complication of malignancy and cirrhosis that frequently leads to hospital admissions. Palliative care is well positioned to address symptom burden through both medical and procedural interventions.

To characterize healthcare utilization among patients requiring paracentesis and evaluate the feasibility, utilization, and safety of an outpatient palliative care procedure clinic.

We conducted a needs assessment at Parkland Health (USA) by identifying patients followed by the palliative care team with stage IV malignancy or cirrhosis who were admitted for paracentesis between 2018 and 2023. Findings informed the development of an outpatient palliative care procedure clinic. A retrospective analysis of the first 12 months was performed, including patient characteristics, procedural outcomes, and symptom burden using the Palliative Care Outcome Scale (POS). A postimplementation satisfaction survey was administered to clinic staff after the pilot year.

A total of 493 patients accounted for 672 hospital admissions requiring paracentesis, with a median length of stay of eight days (interquartile range [IQR], 4-18). During the first year of the clinic, 19 patients underwent 44 outpatient paracenteses. Median age was 50 years (IQR, 43.5-60.5), 63% were female, and 84% had malignant ascites. No immediate procedural complications occurred during a 20-minute postprocedure observation period, and none were identified within seven days on chart review. Median fluid removal was 3500 mL (IQR, 2400-4050 mL). Baseline POS scores demonstrated substantial symptom burden (mean 17.3 ± 5.8). Staff satisfaction with clinic continuation and expansion was high (mean score 4.8/5).

Patients with recurrent ascites experience substantial healthcare utilization and symptom burden. An outpatient palliative care procedure clinic appears feasible and safe in this pilot cohort. Larger studies are needed to confirm safety and evaluate effects on healthcare utilization and patient-centered outcomes.