Developing an integrated pleural service

Pleural clinic gives patients rapid access appointments to assess pleural effusions. If pleural fluid analysis fails, patients are referred for thoracoscopy which was previously performed by the thoracic surgeons. When thoracic surgery was moved to a larger hospital, our respiratory department developed the pleural service to provide diagnosis and treatment in a single setting. A medical thoracoscopy list was set up alongside pleural clinic. Two respiratory consultants were trained in the procedure. The list is also used for placement of indwelling pleural catheters (IPCs). Junior doctors attend the clinic to become competent in thoracic ultrasound and pleural procedures. We audited the procedures done on the thoracoscopy list in the first year and how many led to a successful diagnosis. We performed questionnaires in patient satisfaction and trainee satisfaction. In one year, 15 medical thoracoscopies were performed leading to a definite diagnosis in 11 patients. 27 IPCs were placed. A patient satisfaction survey of ten consecutive clinic patients revealed 100% were satisfied or very satisfied with the service (including organisation, waiting time, procedure and follow-up). All core medical trainees working in respiratory were trained to perform pleural procedures with 100% rating the training as good or excellent. Two registrars not already competent in thoracic ultrasound were able to achieve level 1 competence. The integrated pleural service has enabled rapid diagnosis and treatment of patients without the need to be referred to other hospitals. This has reduced the time waiting for appointments, reduced the need for patients to travel long distances, kept funding within the department and allowed training opportunities for trainees.