title: Cost savings of performing paracentesis procedures at the bedside after simulation-based education.
abstract: BACKGROUND
  Paracentesis procedures are increasingly performed in interventional radiology (IR) rather than at the bedside, and there are few comparative effectiveness data on safety or cost. There is also no consensus about the need for blood product transfusions before the procedure. In a previous study, we reported that the selection of procedure location was largely discretionary and that bedside procedures had equal or better outcomes than IR procedures. Therefore, the aim of this study was to evaluate direct hospital costs of IR paracentesis procedures compared with procedures performed at the bedside by simulation-trained clinicians.
  
  
  METHODS
  We performed an observational study of paracentesis procedures on a hepatology/liver transplant floor at a tertiary care hospital from July 2008 to December 2011. We modeled hospital costs for IR facility use and transfused blood products and calculated the cost of simulation training to compare costs between IR and bedside procedures.
  
  
  RESULTS
  Five hundred eighty-eight patients underwent 764 paracentesis procedures (331 in IR and 433 at bedside). Fifty-one patients (15.4%) with IR procedures received platelet transfusions versus 16 patients (3.7%) with bedside procedures (P < 0.001). Forty-nine patients (14.8%) with IR procedures received fresh frozen plasma transfusions versus 24 patients (5.5%) with bedside procedures (P < 0.001). There were no clinical differences in platelet counts or coagulopathy between groups. In random-effects logistic regression, IR procedures had significantly higher likelihood of platelet (odds ratio, 6.36; 95% confidence interval, 3.28-12.35) and fresh frozen plasma (odds ratio, 3.41; 95% confidence interval, 1.95-5.95) transfusions. Total costs were $663.42 per case for IR and $134.01 per case for bedside procedures.
  
  
  CONCLUSIONS
  Training residents to perform bedside paracentesis procedures was highly cost-effective. This approach should be considered as part of national efforts to reduce hospital costs while providing quality care.
authors.affiliation: From the Department of Medicine (J.H.B., E.R.C., J.F., S.E.K., D.B.W.), and Division of Hepatology (D.G.), Northwestern University Feinberg School of Medicine; and Ralph P. Leischner, Jr., MD, Institute for Medical Education (W.C.M.), Loyola University Stritch School of Medicine, Chicago, IL.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Barsuk
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Kozmic
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Daniel
authors.initials: D
authors.lastname: Ganger
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D001803:Blood Transfusion; D002641:Chicago; D002983:Clinical Competence; D017046:Cost Savings; D017048:Health Care Costs; D006801:Humans; D007318:Inservice Training; D007396:Internship and Residency; D008485:Medical Audit; D019152:Paracentesis / Q000191:economics*; D019095:Point-of-Care Systems / Q000191:economics*; D015641:Radiography, Interventional; D062606:Tertiary Care Centers