Between January 2005 and March 2008, 12 deaths and 15 cases of severe harm relating to chest drain insertion were reported leading to NSPA alert. Live ultrasound-guidance for pleural interventions is now recommended (BTS Guidelines, 2010) and ultrasound marking (X-spot) is no longer acceptable.
At our DGH, a new pleural service has been established to provide a high quality, patient-centered and streamlined service for patients with pleural effusions, performing therapeutic and diagnostic procedures under live ultrasound guidance. It has been designed to improve patient safety, reduce length of stay and offer training opportunities to trainees. A respiratory consultant, trained to level two in thoracic ultrasound, established the pleural service in May 2011. A dedicated side room was equipped with an ultrasound machine and a trolley filled with the necessary equipment for pleural procedures. Pleural service protocol has been developed and approved by the Acute Medicine and the Respiratory departments. Referrals are accepted from inpatient wards, Emergency department and outpatient clinics. The “Inpatient Pleural Service” provides diagnostic/therapeutic pleural procedures 5 days a week within working hours, while a “Ambulatory Pleural Service” is designed to treat patients in an ambulatory setting within 72 hours of referral.
Between 01/05/2011 and 31/04/2012, 83 thoracic ultrasound scans were carried out and 72 ultrasound-guided interventions were performed (26 Seldinger chest drains, 2 PleurX catheters and 44 pleural aspirations). There were only 3 complications reported (2 small pneumothoraces, 1 vasovagal syncope). Patient feedback was excellent with patients particularly appreciating undergoing pleural procedures as a day case. Inpatient length of stay has reduced from 6 days (median) to 1 day (median).
The number of thoracic ultrasounds performed by radiology department decreased significantly from 123 to 84, despite an 11% increase in Emergency department attendances related to closure of a nearby hospital.
The collected data proves that the pleural service increased patient safety, reduced patient waiting times, reduced length of stay, helped avoid admissions, decreased radiology workload and made financial savings.