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Correcting the Tap Leakages

Project Added:
21 October 2015
Last updated:
9 November 2015

Correcting the Tap Leakages


Grafton Base Hospital encouraged general practitioners (GPs) to follow a new care pathway for patients requiring an ascitic tap procedure, to reduce avoidable emergency department ED admissions and improve the patient experience.


To ensure that 100% of patients sent to Grafton Base Hospital for an ascitic tap by a GP are booked via medical imaging for the procedure or referred to the hospital ED for medical review and management.


  • Provides a streamlined and coordinated process for patients, families and carers.
  • Identifies and follows a formal and consistent plan of care for the patient.
  • Enhances efficiency of hospital staff and maximises use of resources.
  • Reduces avoidable ED presentations and admissions.
  • Improves networking and liaison with GPs.

Project status

Key dates

  • Start: November 2014
    Finish: July 2015


  • Implementation - The initiative is ready for implementation or is currently being implemented, piloted or tested.


Prior to the project, patients were referred to Grafton Base Hospital ED by GPs for ascitic taps. In many instances, there was no notification prior to the patient’s arrival, no pathology attended and no admitting physician or doctor booked. The radiologist was often unaware of the patient’s procedure and sometimes not available to do it. This resulted in an increase of unplanned patient admissions, so that pathology could be attended to and a radiologist could be booked to do the procedure. Alternatively, patients were asked to return to the hospital on another day, once all of the required processes have been completed.


Extensive consultation occurred with all key stakeholders. A flowchart of the new process was developed and a letter to GPs was sent out, detailing what was required before a patient is referred to the hospital. Liaison with North Coast Medicare Local took place, with the aim of developing a HealthPathway that would formalise the process and articulate clear guidelines for GPs in Northern NSW Local Health District (NNSWLHD).

Implementation sites

Grafton Base Hospital and GP clinics in the local government area.


  • Clinical Excellence Commission, Executive Clinical Leadership Project
  • North Coast Medicare Local


  • All patients who require ascitic tap procedures and are referred from GPs will be monitored.
  • Compliance with the guidelines and HealthPathway will be measured, once it is developed.
  • Avoidable admission data will be reviewed, to see if ascitic tap patients are included in the results.
  • Feedback from GPs will determine whether the project enhanced communication and collaboration with local GPs.
  • Feedback from consumers will determine whether the project delivered an improved and more streamlined patient journey.

Lessons learnt

Getting commitment from all key parties in the consultation process was challenging.


Heather Baker
Deputy Director of Nursing
Grafton Base Hospital
Northern NSW Local Health District
Phone: 02 6640 2455

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