An intervention focused on increasing the use of bedside pleural ultrasound and hands-on teaching of drainage techniques has been able to improve outcomes in patients with pleural effusions.
The study at the Royal Brisbane and Women’s Hospital found complication rates such as pneumothorax and dry taps following pleural procedures dropped significantly from 22.2 to 7.5% with the intervention.
Repeat procedures, defined as three or more, also reduced significantly from 16.3 to 6.1% and patients were more likely to have intercostal catheters inserted after the intervention.
Dr Timothy Edwards, currently a sleep fellow at the Princess Alexandra Hospital, told the limbic the aim was to improve knowledge of best practice and the risks associated with pleural procedures across a range of medical residents and registrars.
“A TSANZ position paper supports the use of bedside ultrasounds for all pleural procedures. However a previous Australian study found it could be difficult to engage other medical sub-specialties with the pleural pathway.”
Pleural effusion management guidelines, based on British Thoracic Society guidelines, were mandated for the care of all medical patients and presented regularly in grand rounds and registrar education meetings.
Trainees were also given hands-on training in thoracocentesis and intercostal catheter insertion from experienced respiratory physicians, including performing procedures on mannequins and then their patients under supervision.
Following the intervention, the use of bedside ultrasound for pleural procedures increased from 11.7% to 78%. Doctors who completed the training were more likely to use bedside ultrasound than those who hadn’t been trained (87.5 v 5.8%) and had a lower complication rate (5.4 v 24%).
The study found complication rates overall were a low 8.2% in patients when bedside ultrasound was used, compared to 20.5% with ultrasound performed in the radiology department and 21.3% with no ultrasound.
“Trainees liked the fact they could perform the procedure on their own patients and maintain some degree of ownership. They appreciated being shown how to do the procedure in a safe manner and have their input into discussions with the respiratory team.”
About 87% of procedures were performed in accordance with guidelines after the intervention and 80% were appropriately supervised.
Dr Edwards said while most of the trainees probably wouldn’t pursue further training for competency in pleural procedures, they had gained some new skills and were at least aware of the pleural pathway.