Introduction A retrospective profile of medical readmissions within 30 days of discharge (September 2011–December 2011) from a busy district teaching hospital highlighted that a small proportion of patients (12%) with recurrent ascites accounted for 68% of readmissions. Most required large volume paracentesis (LVP) with a mean length of stay of 4 days. We aimed to determine if a viable, safe model for large volume paracentesis (LVP) in an outpatient setting is feasible.
Methods Changes included identifying motivated liver specialist nurses to lead the ascites clinic service, detailed development of local policy and in-patient referral systems for patients appropriate for the service. Patients are initially reviewed in face-to-face clinics allow comprehensive history, examination and augmentation of information to empower individuals to self-monitor and self-refer based on weight and abdominal girth. These are run in tandem with a consultant led hepatology clinic for senior medical support. Where appropriate, follow up can occur by telephone. If necessary, facilitation of same day elective admission for LVP can be arranged. Competent gastroenterology trainees in the day-case endoscopy unit to carry out LVP with same day patient discharge
Results From September 2012 to May 2013, 68 LVPs have been performed in 12 patients. Complications have been few with only one patient having been admitted twice overnight for ongoing large volume paracentesis. Emergency readmissions for LVP have fallen from 68% to 13% over the corresponding period 12 months earlier with an improved patient experience.
Conclusion The ‘Ascites Pathway’ allows safe, effective outpatient LVP with increased patient satisfaction. We feel therefore that LVP is best managed in an outpatient setting with a dedicated nurse-led, medically supported ascites service.
Disclosure of Interest None Declared.
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