Date of Doctor of Nursing Practice Project Completion
Winter 12-18-2026
Faculty Advisor
Dr. Veronica Brady
Abstract
Purpose: The purpose of this quality improvement project was to increase provider compliance with evidence-based, hepatology-recommended ascitic fluid studies among inpatient providers from a baseline of 50% to 60% within five months through electronic health record (EHR) standardization.
Background: Delayed or incomplete ascitic fluid analysis can increase the risk of preventable complications. Workflow variability and non-standardized ordering practices contributed to inconsistent adherence to evidence-based recommendations.
Methodology: Using the Institute for Healthcare Improvement (IHI) Model for Improvement with Plan–Do–Study–Act (PDSA) cycles, two paracentesis workflows were redesigned. For the Mobile Procedure Team, a standardized ascitic fluid panel with six defaulted, evidence-based tests was embedded into the workflow. Due to technical limitations within the Interventional Radiology (IR) EHR build, a standalone panel was created to support the IR workflow. Compliance was evaluated through retrospective chart review with pre–post comparison using descriptive statistics. A Likert-scale survey assessed provider awareness and perceived workflow efficiency.
Results: IR compliance increased to 80%, and Mobile Procedure Team compliance increased to 97.5%. Adherence was higher when the panel was directly embedded in the workflow. Eighty-five percent of providers reported awareness of the updated workflows and improved efficiency.
Implications: Embedding standardized, evidence-based testing into EHR workflows reduced practice variation and improved adherence to specialty recommendations. This low-cost redesign demonstrates how targeted EHR optimization can enhance diagnostic efficiency and may be scalable to other procedural workflows.
Keywords
ascites, quality improvement, electronic health record, standardization.
Recommended Citation
Yimei Zhang, "Standardizing Ascitic Fluid Panel to Improve Outcomes in a Large State Hospital" (2026). Doctor of Nursing Practice Final Project Abstract. 167.
https://digitalcommons.library.tmc.edu/dnp_abstract/167