Chest
Transparency in Health CareReducing Iatrogenic Risk in Thoracentesis: Establishing Best Practice Via Experiential Training in a Zero-Risk Environment
Section snippets
Materials and Methods
All data (except the initial baseline complication data [see introductory comments]) was collected as a quality improvement initiative, but in order to report the results here, we subsequently obtained approval from the Mayo Clinic Institutional Review Board. Our methodology followed the “design, measure, analyze, improve, control” (or DMAIC) framework.9
Phase I of the study included a review of the records of all patients with pleural fluid obtained from a thoracentesis procedure that had been
Demographic Data
We report the results of 363 of 367 patients (4 patients were excluded from the study due to lack of research consent) who underwent thoracentesis in our outpatient clinic in the 2 years following our quality intervention compared to the 58 preintervention patients (Table 1). More thoracenteses were performed on the right side and on men. Therapeutic thoracentesis performed solely for symptom relief was less common (18%).
Rate of Pneumothorax and Tube Thoracostomy
Prior to the institution of our quality improvement intervention, our rate
Discussion
The culture of procedural training in medicine has, for decades, been focused on experiential training using human subjects with the often-heard educational motto “see one, do one, teach one.”11 As a result, the adoption of a zero-risk environment for initial thoracentesis instruction was not previously used at our institution. The basis of our (phase II) methodology to train physicians with the use of ultrasound and to assure procedural competency included the creation of a zero-risk
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This research was supported by Mayo Clinic Institutional Funds.
The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).