Abstract
The rising incidence of chronic liver disease has resulted in many patients needing recurrent paracentesis for abdominal ascites, which requires hospital admission. A novel nurse-led and delivered day-case paracentesis and intravenous infusion service was developed, and a cost-benefit analysis was undertaken to examine the impact of this service. Data for patients admitted for ascitic paracentesis and intravenous infusions between April and January 2016 were collected, and procedure-related costs and income were calculated. Savings delivered by the service were calculated by determining the cost of bed-days saved by the day-case service. A qualitative analysis of the efficacy of the service was conducted by a patient feedback survey. Over the 10-month period, 559 patients were treated by the day-case service—144 ascitic paracenteses (26%), 87 iron infusions (16%), 307 infliximab infusions (55%) and 21 magnesium infusions (3%). Net income over 10-months was £256 876, with an expenditure of £128 570, yielding a profit of £128 306. Cost-modelling exercises indicated that this would yield an additional cost saving of £153 216 due to inpatient bed-days saved, yielding a total financial benefit of £281 522 (over 10-months). A day-case, nurse-led gastroenterology service provides an innovative, profitable and cost-efficient model of service delivery.
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