Review of respiratory physician inpatient pleural ultrasound service

Introduction: The appropriate and timely investigation, interventions and management of pleural effusions remains discrepant with variable practices and pathways, possible impacting upon quality of care. Aims: To ascertain the qualitative and quantitative outcomes of running a Respiratory physician led inpatient pleural ultrasound service. Methods: A prospective analysis of 12-18 month experience in a district general hospital of providing an inpatient pleural service by chest physicians with thoracic ultrasound. Results: From May 2010 to date (10 months) 111 patients were included. We compare the pleural disease activity level pre and post establishing of this service. Table 1. Overview Pre & Post establishing Inpatient Pleural Ultrasound Service 2009 2010 2011 May 2010 to Feb 2011 Total number of Radiology Departmental Pleural Ultrasounds 93 113 6 67 Number of “X” marks the spot by Radiology Department 55 17 1 1 Number of Physician ward based Pleural Ultrasounds 0 82 29 111 The remit and breadth of inpatient pleural service and interventions undertaken are as follows. Table 2. Type of Inpatient Pleural Ultrasound & Intervention Type / Intervention Number of patients Diagnostic US (No intervention) 35 Pre Medical Thoracoscopy 5 Diagnostic pleural aspiration 33 Therapeutic pleural aspiration 3 Diagnostic & Therapeutic pleural aspiration 22 US guided intercostal chest drain 13 Total 111 Conclusion: Provision of an inpatient pleural service does require work planning and resources but results in qualitative and quantitative improvements in patient care including: improved clinical practices by avoiding “X” marks the spot; pleural interventions done quicker and safely with no complications to date; and improved pathways for patients with pleural disease.