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Introduction This quality improvement project evaluated whether patients admitted to King’s Mill Hospital with decompensated liver cirrhosis and clinically detectable ascites received diagnostic paracentesis promptly (within six hours), in accordance with BSG guidance. Given the known association between delayed paracentesis and increased mortality (each hour delay associated with 3.3% increase in in-hospital mortality), a two-cycle QI project was conducted to assess local practice and implement interventions where standards were not met.Methods A retrospective review was performed on approximately 20 patients admitted over a period of one month with decompensated liver cirrhosis and new or worsening ascites. Data collected included whether diagnostic paracentesis was performed, time from admission to procedure, and any documented reasons for delay. First-cycle findings were compared against BSG standards and revealed gaps between recommended care and current practice. A survey was conducted amongst staff responsible for the care of decompensated cirrhosis patients. This helped identify factors contributing to delays, which informed targeted interventions:Educational posters in acute areas highlighting the six-hour target and clarifying misconceptions regarding contraindications to the procedure.Updates to the Trust decompensated cirrhosis care bundle to explicitly state the recommended timeframe for diagnostic paracentesis.Dissemination of findings at departmental meetings through presentations.A second cycle of data collection was then conducted to assess the impact of these measures, following which a further intervention was made:The Introduction of an ascitic tap order set within the electronic investigation system.Results In the first cycle, 60% of patients received diagnostic paracentesis when indicated; only 10% within six hours of hospital admission, and 15% within six hours of medical clerking. Mean time from admission to paracentesis was 26.75 hours, and from clerking to procedure was 22.57 hours. Following interventions, the second cycle showed 78% of patients received paracentesis when indicated. No patients underwent the procedure within six hours of admission, while 10% received it within six hours of clerking. Mean time from admission to procedure was 36.03 hours, and from clerking to procedure was 27.36 hours.Conclusions The study demonstrated that while most patients eventually received diagnostic paracentesis, very few underwent the procedure within the recommended six-hour timeframe. Despite targeted interventions, delays from both admission and clerking persisted. Further cycles of the project are underway to assess further interventions and improve practice by ensuring timely paracentesis, so that clinical care better aligns with BSG standards.