Background It has been standard practice for all patients to have US prior to paracentesis. This involved:
Ambulance transfer to/from Acute Hospital in Southampton [SGH]
Cost average=£600 per patient
Increased length of stay by 4–7 days, awaiting scan at SGH
Poor patient experience.
50% of our patients died within 10 days of paracentesis, indicating their general frailty and the importance of short admission.
Intervention A portable ultrasound machine was purchased by Countess Mountbatten House Hospice at £5780. Suitable training was undertaken by the author at £450.
Results 50 scans were performed over one year:
2 at home: both no ascites [died at home within seven days]
17 in OPA: 8 admitted for paracentesis
9 no ascites [ 1 U.retention – catheter inserted ]
31 in IPU: 17 ascitic drains placed
9 no ascites
5 catheters inserted for U.retention
11 admissions avoided
31 transfers avoided [31x £600]=£18600
124 bed days saved [31x4 minimum wait for scan at £294 per day]=£ 36456
OutcomesPatient experience improved:
Unnecessary admission avoided
Faster relief of symptoms
Reduced length of stay.
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