The BTS made recommendations on pleural services. In order to stream-line the elective pleural procedures (other than thoracoscopy) a mid-week session was initiated on the pleural unit at a teaching hospital providing for over 500,000.
Aims To review the impact of a mid-week dedicated pleural session (DPS) Consultant –led and advanced nurse practitioner (ANP) -supported on the ward –based thoracic ultrasound (US) and pleural procedure training of respiratory trainees and impact on other hospital services.
Methods This is an analysis of data collected prospectively at the time of the US and procedures over 1 year. US referred to radiology were obtained from a search on radiology database. Changes over a period of six months after the DPS was started were assessed against the six months before. SPSS programme and Chi2 test were used.
Results The numbers of US and procedures over 6 months was similar before and after the DPS (N = 297 vs. 260). Procedures performed on a Monday were less after DPS (Chi2 = 9.21, p < 0.01), but not for Thursdays and Fridays.
Procedures done by trainees under Consultant supervision increased with the DPS (Chi2 = 5.45, p = 0.019), so did those performed by the ANP (from 25 to 66 procedures, Chi2 = 23.4, p < 0.001).
The proportion of chest drains inserted out of hours was 1.8% all were done by trained respiratory juniors. 20% US and procedures were referred by other departments.
US performed in radiology were 4%, 0.7% referred by the respiratory teams and the rest mainly from intensive care.
No major complication (death, organ injury, empyema, bleeding) occurred. All specialist registrars reached level 1 US.
Conclusion A dedicated mid-week pleural procedures session improved the training and supervision for respiratory trainees and provides a safe service.
This session reduced the burden of procedures performed on Mondays but was not sufficient to reduce the numbers performed before the weekend. An additional session is planned for Fridays.
A level 1 thoracic US trained ANP assisted the training of juniors and the provision of service.
Most pleural US and procedures are performed on the pleural unit, which reduced the burden on radiology department.
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