Background Facilitating preferred place of care and death (PPC/PPD) are important aspects of good palliative care. Disease progression, increasing frailty and reduced mobility are associated with increased incidence of thrombosis (DVT) and urinary retention causing distress and sometimes admission. The development of ascites is another indicator of general frailty (50% died within 10 days of paracentesis) and the importance of short admission. The development of our portable ultrasound facility was envisaged as a useful tool to improve delivery of care and assist achievement of PPC/PPD.

Intervention Availability of the portable ultrasound machine to all Countess Mountbatten House teams to identify/exclude ascites, DVT, Urinary retention and to assist transfusion/hydration when cannulation is difficult.

Results 50 scans were performed over eight months:

4 at home: 4 no ascites (2 died at home within 9 days, 1 U.retention – catheter inserted, 1 cellulitis with indwelling drain – admitted)

19 in OPA: 8 ascites – admitted for paracentesis

7 no ascites [2 GB abscess, 1 U.retention]

2 DVT confirmed [anticoagulated at home]

2 DVT excluded

27 in IPU: 11 ascitic drains placed

7 no ascites [5 U.retention – catheter inserted]

5 DVT confirmed [anticoagulant started]

3 assisted cannulations for transfusion

1 pericardial effusion (transferred to cardiology).

Outcomes

• 14 admissions avoided

• 26 transfers for scan or central line avoided

• 4 units of blood not wasted

• 104 bed days saved [26 × 4 days minimum wait for scan]

OutcomesPatient experience improved:

• Unnecessary admission avoided

• Transfer avoided

• Faster relief of symptoms

• Reduced length of stay.