P261 A dedicated pleural service in a large teaching hospital: can we provide a timely in-reach response?. (December 2018)

• Record Type: Journal Article
• Authors: Abi Musa Asa'ari, AKA; Haris, M; Youssef, S; Iftikhar, S; Muneer-Ahmed, S; Niazi, B; Bikmalla, S; Ganaie, B; Cusay, T; Antony, M; Ganaie, MB; Iqbal, M; Khan, S; Maddekar, N
• Is Part Of: Thorax. Volume 73(2018)Supplement 4
• Page Start: A243
• Page End: A244
• Publication Date: 2018-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2018-212555.417
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction: Pleural disease affects a significant portion of the population with an incidence of 3000 people per million each year resulting in increased morbidity and mortality. Many patients present acutely to secondary care requiring timely pleural review and interventions as appropriate. Over the last decade, there has been a move towards enabling streamlined specialist-led management pathways through dedicated pleural services. Aims: We wish to review the in-reach activity of a dedicated 5 day pleural service (managed by 5 respiratory consultants with an interest in pleural diseases, clinical fellow in pleural and advanced bronchoscopic interventions and pleural nurses) in a large 1200 bedded university hospital focusing on the time from referral to pleural consultation. Methods: Consecutive inpatient referrals made to the pleural service via electronic referral system were reviewed between October 2017 and February 2018; referrals from Emergency Department (ED) and acute ambulatory care (AEC) were excluded. Referral source, time of referral to pleural review and interventions data was analysed. Results: Of the 509 patients reviewed by the pleural team, 217 were in-patient referrals. Mean (range) 70 (18–96) years; female: male 111 (52%): 106 (48%). Source of referral: acute medical unit 14 (6.5%), medical wards including short stay 173 (79.7%), surgical wards 13 (6%), oncology 17 (7.8%). Time of referral to pleural review (see figure 1); 89 (41%) were reviewed the same day and 62 (28.6%) the following day of referral. Pleural effusion 203 (93.5%), pneumothorax 7 (3.2%), hydropneumothorax 7 (3.2%). 92 (42.4%) had chest ultrasound assessment only; 72 (33.2%) diagnostic and therapeutic aspiration; 28 (12.9%) chest drain insertion; 10 (4.6%) chest drain removal; 2 indwelling pleural catheter (IPCs) insertion; 1 IPC removal; 1 required drainage and talc; 3 did not require any intervention. Conclusion: Our data demonstrates the role of a dedicated pleural service in providing expeditious inpatient reviews. More than two-third pleural inpatient referrals were reviewed by the pleural team within the next working day. A timely specialist review should translate into reduced length of stay, reduced risk of potential procedure related complications, duplication of procedures, early diagnosis and improved outcomes.