A combined hands-on teaching program and clinical pathway focused on pleural ultrasound and procedure supervision transforms pleural procedure outcomes

Introduction Management of pleural effusions is a common diagnostic and management problem. We reviewed the outcomes from pleural procedures after the instigation of pleural effusion management guidelines focusing on pleural ultrasound and a hands-on teaching program followed with procedure supervision that enabled many operators to perform such procedures. Methods A retrospective analysis of all procedures performed for pleural effusions on medical patients. Outcomes were assessed prior to the instigation of pleural effusion management guidelines (pleural pathway) and hands-on teaching (January 2010 to June 2011) and following these interventions (January 2012 to June 2013). Results 171 procedures involving 129 patients (pre-pathway group) and 146 procedures involving 115 patients (post pathway group) were analysed. The rate of complications prior to the pleural pathway was 22.2% (38 of 171 procedures). Following the pathway, the rate of complications declined to 7.5% (11 of 146 procedures, p < 0.003). The use of pleural ultrasound increased dramatically (72.5% vs 90.2%). The number of patients who underwent repeated procedures (defined as ≥3) reduced dramatically (21 vs 7, p < 0.01). This improvement occurred using many supervised operators who completed the hands-on teaching program (n = 32) and followed the pleural pathway (127 of 146 procedures). Conclusions The instigation of a clinical pathway focused on the use of bedside pleural ultrasound and teaching of drainage techniques with procedure supervision vastly improved patient outcomes. This not only allowed better quality of care for patients, it also provided the acquisition of new skills to medical staff, not limiting these skills to specialised staff.