PT - JOURNAL ARTICLE AU - Conceição Santos AU - Saurabh Gupta AU - Stephanie Naim AU - Jonathan Williamson TI - Outcomes of an initiative to improve safety of medical thoracostomy tube insertion AID - 10.1183/13993003.congress-2015.PA2495 DP - 2015 Sep 01 TA - European Respiratory Journal PG - PA2495 VI - 46 IP - suppl 59 4099 - http://erj.ersjournals.com/content/46/suppl_59/PA2495.short 4100 - http://erj.ersjournals.com/content/46/suppl_59/PA2495.full SO - Eur Respir J2015 Sep 01; 46 AB - Background: Tube thoracostomy is a common hospital procedure with several documented risks, which include life threatening complications such as pneumothorax (rates 2-30%), visceral damage, tube displacement and tube blockage.Methods: In a major metropolitan tertiary hospital, we performed an audit of outcomes in inpatients undergoing small bore intercostal catheter insertion (ICC) over a 2 year period. This was followed by a comprehensive quality improvement initiative involving limiting the number of procedural clinicians, training in thoracic ultrasound, using a dedicated pleural procedure room, training nursing staff in assisting ICC insertion and ensuring senior supervision when junior medical officers were inserting ICC's. Results over the next 2 years were then reassessed.Results: Preliminary results are presented in Table 1. Image guidance became universal after implementation of the QI initiative. The rate of pneumothorax requiring intervention fell and although the rate of radiologically detectable pneumothorax remained, all were documented <1.5cm in size. Documentation and patient pain control improved. OUTCOMESPRE INTERVENTION N=102POST INTERVENTION N=70Image Guidance24(23%)70 (100%)Pneumothorax6 (6%)13 (18%)Pneumothorax requiring intervention1 (1%)0Chest wall infection1 (1%)0Pain14 (14%)0Insufficient Documentation9 (9%)0TABLE I - ICC INSERTION AND COMPLICATIONSConclusions: We have documented that a comprehensive quality improvement initiative prevents complications, improves patient experience and documentation when applied to inpatient ICC insertion.