Having personal experience of the tremendous support provided by the local hospice, and noting the lack of ultrasound facilities the author (an experienced sonographer) approached the hospice Medical Director to discuss developing a volunteer on-site ultrasound service. BMUS Ultrasound Clinical Governance Guidelines (October 2008) were consulted to draw up a ‘Service Description and Guidelines for Best Practice’ protocol. An ultrasound machine was generously donated by Spire Healthcare Group and a hospice scanning service started in July 2013
Over the following year 58 scans were carried out on 52 patients.
A wide range of pathologies were found, from disease progression to gallstones accounting for pain. 13 people had abdominal ascites, 5 of whom had successful paracentesis following the scan and skin marking for a drain site (8 were not drained due to their overall condition). Negative findings following suspected DVTs were particularly valued.
Three people are lost to follow-up. Of the remaining 49 people, 46 have died now; their post-scan survival ranged from 3–359 days, with a median of 32 days and a mean of 60 days. Three people are still alive (post-scan survival up to 22 months as of 30/04/15).
Establishing guidelines to ensure safe practice and to equip staff with confidence to request a scan, and learning when a scan would be helpful has taken time but we have been able to demonstrate that a hospice based service is achievable, effective and safe. Clinicians and patients value not having to travel for a hospital scan when poorly and having more certainty in clinical scenarios when symptoms and signs are subtle or complex.
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