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Management and organisation of respiratory health care
P28 A Successful Ambulatory Pathway For Elective CT Guided Lung Biopsy Which Reduces Bed Days is Co-Dependant on Adequate Discharge Planning Including a Pathway For Managing Patients with Small Pneumothoraces
  1. M Tufail,
  2. T Hussain,
  3. E Hadley
  1. Barking, Havering and Redbridge NHS Trust, Ilford, Essex, UK

Abstract

Introduction and Objectives CT guided lung biopsy is a cost effective and reliable method to diagnose lung malignancy. The procedure has a low morbidity and mortality although pneumothorax complicates up to 61% of all lung biopsies.1 Patients were previously admitted for this procedure but the lack of beds and the resources prompted the conversion to an out-patient service.2 The aim of this study was to look at how a new policy for day-case CT guided biopsy of the lung affected bed-days, in particular those patients with a post biopsy pneumothorax.

Methods We collected data on CT guided lung biopsies, its complications and bed days per biopsy during 2008 when procedure was performed as inpatient and compared it with the findings when procedure was performed as day case between 2009 and 2011.

Results During 2008 we performed 35 CT guided lung biopsies as inpatients. Total bed days per biopsy were 2.31(81/35). With the introduction of a day case procedure in 2009 total bed days per biopsy were remarkably reduced to 0.12 (9/73). Post biopsy pneumothorax rate was 18.8% (13/73) over 3 years, but only one patient required treatment with a chest drain 7.7% (1/13). However 9/13 patients were admitted for observation irrespective of the symptoms and size of the pneumothorax.

Conclusion We present evidence that the implementation of a successful day-case CT biopsy pathway has dramatically reduced bed days per successful biopsy. We have demonstrated that a further pathway for the ambulatory management of post-biopsy complications would further reduce this figure by a factor of 10 from 0.12 to 0.014 days (1/73)[see table). We recommend discharging suitably selected patients with small asymptomatic pneumothorax with an appropriate information leaflet. A CXR to confirm resolution of the pneumothorax could be done when the patient returns to clinic for their biopsy results.

Abstract P28 Table 1

CT guided lung biopsies, complications and bed days per biopsy from 2008–2011

References

  1. MacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010; 65.

  2. CT-guided cutting needle biopsy of lung lesions–safety and efficacy of an out-patient service. Charig MJ, Phillips AJ. Clin Radiol. 2000 Dec; 55(12):964–9.

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