Background Ultrasound is an increasingly important diagnostic and therapeutic tool in palliative care. Ultrasound use within the community, prevents hospital admissions and supports preferred places of care. Few studies describe the indications, outcomes and complications of ultrasound use in a community setting.
Aim Review and evaluate the use of Focused Abdominal Ultrasound (FASP) at St Joseph’s Hospice, over six years.
Methods A retrospective review of data from ultrasound logbooks and computerised clinical records between May 2012 - April 2020.
Results 410 ultrasounds were performed, 3 (<1%) of these were in the patient‘s own home. All scans were performed by a Palliative Medicine Consultant or Clinical Fellow trained in use of FASP.
Clinical indication was broadly split into malignant and non-malignant, 64% vs.36% respectively.
Identified indications include; ascites 74% (302); urinary retention 19% (78); constipation or overflow 5% (9); deep vein thrombosis 1% (5); pleural effusion <1% (3); assessment of mass <1% (2) and spontaneous bacterial peritonitis <1% (1). 41% of the 302 ultrasounds for ascites, resulted in paracentesis. Major and minor complications rates, 0% vs. 8% respectively, were reviewed over 4 weeks. Failure of procedure was the highest minor complication rate at 2%. Persistent leakage from drain site, infection, local skin reaction and an asymptomatic drop in blood pressure had complication rates of <1% each. Data trends show the number of ultrasounds performed each year is decreasing, however, paracentesis rates remain relatively stable, suggesting more targeted use.
Conclusions Community ultrasounds reduce hospital transfers, admissions and need to access hospital-based radiology services. With appropriately selected patients, the low complication rates, support continued use of community paracentesis. Patient views and preferences on the location of performing ultrasounds and procedures would be valuable. This combined with projected cost savings, has the potential to demonstrate and endorse the importance of these community-based services.
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