Shadi Dowlatshahi, MD

Therapeutic fluid extraction procedures such as therapeutic paracentesis and thoracentesis can generally be safely performed in an ambulatory clinic instead of urgent care settings. Of the three Department of Health Services (DHS) sites with an Emergency Department (ED), only one facility (Olive View Medical Center (OVMC)) offers a paracentesis clinic, while Harbor-UCLA Medical Center (HUMC) and LACUSC do not. Despite the availability of a clinic at OVMC, patient demand exceeds the capacity of the clinic, resulting in patients presenting to the ED for these procedures, that may also lead to unnecessary hospitalization for management. Most patients presenting to the DHS EDs, either on their own or referred by their providers, do not need ED care or hospital admission for paracentesis or thoracentesis. This over-utilization of valuable ED and inpatient resources compromises patient access and timeliness of care, as well as risks denied hospital days and poor patient satisfaction. 

To address this need, we developed and piloted a fluid aspiration (FLASP) clinic at LACUSC to decrease this demand for urgent care. In this project, we will expand FLASP clinic hours and offer educational and procedural interventions to promote use. We hypothesize that this project will increase clinic use and decrease urgent care use. We will conduct a mixed methods study with key informant interviews to assess patient and provider barriers and facilitators to FLASP clinic use that will guide the intervention. We will quantitatively evaluate our primary outcome, reduction in unnecessary ED use from 30-40 patients per month to 5-7 patients per month, as well as other process measures including reduction in denied hospital days, reduction in hospital admissions, improved patient satisfaction and improved knowledge of patients regarding their disease.