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]

• Nurse escort

• Admin time

• 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

Outcomes

• 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

• Transfer avoided

• Faster relief of symptoms

• Reduced length of stay.