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

Robert Nathanson, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, United States. nathansonr3@uthscsa.edu.
Rahul Khosla, Department of Pulmonary, Critical Care and Sleep Medicine, The George Washington University, Washington, DC, United States.
Rebecca Theophanous, Emergency Medicine, Durham VA Healthcare System, Durham, North Carolina, United States.
Zahir Basrai, Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States.
Abdulkareem A. Agunbiade, Emergency Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States.
Christopher Schott, VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, Pennsylvania, United States.
Jeremy Boyd, Vanderbilt University Medical Center, Department of Emergency Medicine, Nashville, Tennessee, United States.
Michael J. Mader, South Texas Veterans Health Care System, Research Service, San Antonio, Texas, United States.
Kevin J. Murray, Louis Stokes Cleveland VA Medical Center, Medicine Service, Cleveland, Ohio, United States.
Jacqueline A. Pugh, Division of Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Dr, MC 7982, San Antonio, 78229, Texas, United States.
Erin P. Finley, VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), Los Angeles, California, United States.
Nilam J. Soni, South Texas Veterans Health Care System, Medicine Service, San Antonio, Texas, United States.

Document Type

Journal Article

Publication Date

8-12-2025

Journal

BMC medical education

Volume

25

Issue

1

DOI

10.1186/s12909-025-07656-z

Keywords

Clinical outcomes; Education; Point of care; Procedures; Ultrasound

Abstract

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.

Department

Medicine

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