RT Journal Article
SR Electronic
T1 Outcomes of an initiative to improve safety of medical thoracostomy tube insertion
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA2495
DO 10.1183/13993003.congress-2015.PA2495
VO 46
IS suppl 59
A1 Conceição Santos
A1 Saurabh Gupta
A1 Stephanie Naim
A1 Jonathan Williamson
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/PA2495.abstract
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.