Somerset Foundation Trust wins Patient/Carer Experience Award for ‘pioneering’ service

Somerset NHS Foundation Trust has been awarded the Patient/Carer Experience Award of the Somerset FT Allied Health Professions Festival Day for its paracentesis service.

Led by consultant sonographer clinical service lead Steven Savage and consultant sonographer Helen McLean, the outpatient palliative ultrasound interventional service includes abdominal ascitic (paracentesis) drainage and plural effusion aspiration service. 

This service has now expanded to include domiciliary paracentesis where the abdominal drain is performed in the patient’s home. 

Care, compassion, flexibility, and forward thinking

The pair were awarded the Patient/Carer Experience award for their care, compassion, flexibility and forward thinking to provide the domiciliary ultrasound service in Somerset, the citation explained.

Mr Savage and Mrs McLean also introduced the domiciliary paracentesis service, where they perform drains in the patients’ homes in the last six weeks of their life.

They said they believed this to be a “first, as far as we are aware” in the country. 

Lynchpins of the service

The acquisition of a small, handheld portable ultrasound system enabled the ultrasound team at Somerset Foundation Trust’s Yeovil site to introduce the domiciliary paracentesis service to improve the comfort of bedbound end-of-life patients across the whole of Somerset.

Mr Savage and Mrs McLean were described as “lynchpins” in offering and coordinating this service, which involves a collaborative multidisciplinary approach with the Palliative and Community teams, along with patients and their families

They said: “We were delighted to receive the Patients/Carers Experience Award at the Somerset Foundation Trust Allied Health Profession Festival Day. We are so fortunate to have the support of our amazing colleagues and be able to make such a difference to patient care with this innovative approach.

“It is a privilege to be able to offer this service and provide some comfort to end-of-life patients in Somerset when they and their loved ones are at their most vulnerable.”

Dangers of paracentesis

Previously, end-of-life cancer patients with suspected build-up of abdominal fluid who were not able to attend the hospital for an outpatient paracentesis often had no other option other than to be admitted into hospital for this procedure.

Ultrasound is able to identify a safe site for drainage and to confirm the distension is due to ascites build up.

The presence of increasing fluid causes symptoms of initial discomfort that quickly progress to pain, difficulty in breathing, loss of appetite, incontinence and swollen legs if not addressed.

To alleviate this, a drain is inserted under ultrasound guidance into the abdomen to facilitate removing the fluid and improving patient comfort and breathing.

A more comfortable environment

Patients in their last weeks of life struggle to attend a hospital for drainage to be performed. They may have complicated care plans or comorbidities that will make care in the acute setting difficult to provide, as well as exposing a vulnerable patient to hospital-acquired infections.

Coordinating patient transport at short notice to coincide with a scan appointment can also be challenging, the pair said. 

As ambulance transport systems are currently facing severe demand, patients may face delays or cancellations, or be left waiting for collection on a stretcher for hours – which can be “distressing” for all those involved.

Simplifying the process from hospital to  home has allowed patients to undergo the procedure in a more comfortable environment – “while on their own settee, with a cup of tea, or in bed”, the pair said.

Allied Health Professions Day is held on 14 October every year, giving AHP teams a chance to connect and celebrate their roles.

(Image: Helen McLean (L) and Steve Savage, via Somerset NHS FT)