P208 Using a regional network to identify trends in practice of and training in pleural procedures

Introduction There has been variation in practice of pleural procedures between hospitals, despite clear guidance from the BTS and other bodies.1 It causes significant anxiety out of hours for General Medical (GIM) registrars (SpRs), whose experience with these procedures has reduced since the advent of mandatory thoracic ultrasound. Aims We assessed practice in eight hospitals across a training deanery to identify trends that may enable a more standardised approach to training and practise of pleural procedures both in and out of hours. Methods We used the PRISM network to disseminate a questionnaire to all Respiratory and GIM registrars and consultants. Domains included number of procedures performed, self-rated confidence undertaking them out of hours and the availability of standard operating procedures (SOPs), safety checklists and procedure rooms. Results 137 responses were received from eight hospitals. 90.4% of respondents said that out-of-hours procedures were the responsibility of the GIM SpR. 39 GIM SpR respondents had a mean confidence of 2.4 (95% CI 2.09, 2.78) (Likert 1 not confident-5 very confident in performing said procedure in an emergency, compared to 3.9 (95% CI 3.26, 4.55) amongst respiratory respondents. 70.7% of GIM SpRs desired further training. 53.3% of respondents knew of a pleural safety checklist and only 20.7% knew of it being used regularly. 53.0% did not know where to find the SOP for pleural procedures. Respiratory consultants felt that trainees require more experience to achieve competency than their GIM counterparts. 18.0% of respiratory trainees had regular access to a procedure room and only 15.8% had dedicated time in their schedule for procedures. Discussion As expected, there was a wide variation in practice and experience across multiple trusts and specialties. While it remains on the GIM curriculum, it is important to ensure that non-respiratory trainees have their confidence and experience increased. Further work will look to address this by piloting a formalised training programme with certification across multiple sites via the PRISM network, and looking to increase access to SOPs. Reference Havelock T, Teoh R, Laws D, et al. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax 2010;65:i61–i76