Paracentesis complication rates and use of ultrasound: impact of a point-of-care ultrasound training course in the veterans affairs healthcare system.

BACKGROUND: Point-of-care ultrasound (POCUS) training courses have been shown to increase knowledge and skills among physicians, but few studies have examined their impact on clinical outcomes. We assessed the frequency of ultrasound usage and complication rates of paracentesis after implementing a POCUS training course in the Veterans Affairs (VA) health care system. METHODS: A retrospective observational study was conducted of VA medical centers that participated in a POCUS training course ("trained facilities") versus matched control facilities. Rates of paracentesis performed in non-radiology settings with and without ultrasound guidance and procedural complications were collected from the VA corporate data warehouse (CPT and ICD-10 procedure and diagnosis codes) and pre- and post-course surveys of course participants. A best fit linear regression line was established for quarterly rates of each group and the y-intercept and slope of each line was compared. RESULTS: Data were compared from 16 trained versus 32 matched control facilities where 10,375 and 22,103 paracenteses were performed, respectively, from October 2015 to March 2025. At baseline, ultrasound guidance was used less frequently in trained versus matched control facilities (39% vs. 78.3%, p < 0.0001). However, trained facilities demonstrated a greater quarterly increase in ultrasound use (1.20% vs. -0.14% per quarter, p < 0.0001). By the end of the study, trained facilities surpassed control facilities in use of ultrasound guidance (84.6% vs. 73.0%, p < 0.001). The overall complication rate was low (2.4 per 1,000 procedures) and there was no significant difference in trends between trained and matched control facilities. CONCLUSIONS: Participation in a national POCUS training course was associated with increased use of ultrasound guidance for paracentesis but not with statistically significant changes in complication rates. Further study is warranted to explore effect of POCUS training on procedural outcomes of paracentesis.

Duke Scholars

Author Rebecca George Theophanous Emergency Medicine