P056 Tapping into ascites: service evaluation of elective day-case paracentesis

Field: Health Professions (Health Sciences)

Background

Liver disease has been on the rise since 2011, with 138.3 per 100,000 people being admitted to hospital with it as a primary diagnosis as of 2019.1 Ascites is the most common complication of liver cirrhosis. Large-volume paracentesis necessitates hospital admissions.2 3 Elective day-case paracentesis was introduced into the our trust in July 2019 to reduce inpatient bed occupancy. It was established under the condition of regular service review to ensure ongoing safety and cost-savings. This is a service evaluation following a 2019 review.

Objective

To evaluate the complication rates and cost-savings of day-case paracentesis in patients with ascitic liver-disease.

Methodology

Six months' cumulative data was collected retrospectively via the hospital's online clinical system for all day-case paracentesis between January and October 2020, excluding the coronavirus lockdown period. The data collected included: patient demographics, date and time of admission and discharge, volume drained, and complications. Cost-savings was based on avoidance of inpatient bed days per paracentesis compared to the 2017–18 average (3.5 days using inpatient paracentesis), cost per day-case and any readmission bed days within 7-days. Complications requiring hospital admissions or additional interventions were reviewed.

Results

9 patients with a total of 28 episodes of day-case paracentesis were included. The average length of stay was found to be 0.48 days. This is similar to the 2019 service evaluation (0.50 days) and less than the 3.5 days average of 2017–18 when inpatient paracentesis was used. 3 of 28 episodes were admitted with 2 requiring albumin cover overnight and 1 incidentally found to be anaemic and thrombocytopenic requiring transfusion. Therefore, 25 episodes of inpatient admissions were avoided. Using data from NHS Improvement, cost savings per episode of inpatient admission avoided was calculated to be £1,899.4 Hence, over this 6-month period, the total savings were £1,899 x 25 episodes = £47,475. Decreased length of stay reduces admission costs and the risk of exposure to hospital-acquired infections and other potential complications. This planned and pre-emptive draining pathway enhances patient quality of life compared to going through A&E triage. No significant complications were found.

Conclusion

Day-case paracentesis at our trust resulted in substantially reduced healthcare costs compared to inpatient paracentesis without compromising patient safety.

References

Liver disease profiles: statistical commentary, February 2020 [Internet]. GOV.UK. 2020 [cited 2020 Oct 28]. Available from: https://www.gov.uk/government/publications/liver-disease-profiles-february-2020-update/liver-disease-profiles-statistical-commentary-february-2020 When to suspect cirrhosis | Diagnosis | Cirrhosis | CKS | NICE [Internet]. [cited 2020 Oct 28]. Available from: https://cks.nice.org.uk/topics/cirrhosis/diagnosis/when-to-suspect-cirrhosis/ Complications | Background information | Cirrhosis | CKS | NICE [Internet]. [cited 2020 Oct 28]. Available from: https://cks.nice.org.uk/topics/cirrhosis/background-information/complications/ NHS Improvement. Archived Reference Costs [Internet]. [cited 2021 Apr 11]. Available from: https://webarchive.nationalarchives.gov.uk/20200501111106/https://improvement.nhs.uk/resources/reference-costs/