Early outcomes following the implementation of a specialised pleural disease service.

Abstract

Pleural effusion is common cause of hospitalisation and a poor prognostic marker that is associated with morbidity and mortality. The evaluation and management of pleural effusion may be performed more effectively by a specialised pleural disease service (SPDS). To evaluate the impact of a SPDS, established in 2017 at a 400-bed metropolitan hospital in Victoria, Australia. A retrospective observational study was undertaken, comparing outcomes of individuals with pleural effusions. People with pleural effusion were identified using administrative data. Two 12-month time periods were compared, 2016 (Period-1, pre-SPDS) and 2018 (Period-2, post-SPDS). Period-1 had n = 76 and Period-2 had n = 96 individuals with pleural effusion receiving intervention. Age (69.8 ± 17.6 vs. 71.8 ± 15.8), gender and Charlson Comorbidity Index (4.9 ± 2.8 vs. 5.4 ± 3.0) were similar across both periods. Utilisation of point-of-care ultrasound for pleural procedures increased from Period-1 to Period-2, 57.3% to 85.7% (p < 0.001). There was a reduction in median days from admission to intervention (3.8 days to 2.1 days (p = 0.048) and pleural-related re-intervention rate (32% vs. 19%, p = 0.032). Pleural fluid testing was more consistent with recommendations (16.8% vs. 43.2% (p < 0.001). Overall, there was no difference in the median length of stay (7.9 vs. 6.4 days, p = 0.23), pleural-related readmissions (11% vs. 16%, p = 0.69) or mortality (17.1% vs. 15.6%, p = 0.79). Procedural complications were similar between the two periods. The introduction of an SPDS was associated with increased point-of-care ultrasound utilisation for pleural procedures, shorter delays to intervention and improved standardisation of tests on pleural fluid. This article is protected by copyright. All rights reserved.