The need for including pleural procedure sessions in respiratory physicians' job planning in the United Kingdom

Background: In 2008, the UK National Patient Safety Agency (NPSA) issued an alert for risks associated with insertion of intercostal chest drains (ICD) and highlighted issues related to insertion by non-specialists and by inadequately trained or supervised junior doctors. Methods: In an acute hospital (catchment population about 280000), an education campaign targeted at emergency medicine on-call doctors was started in August 2008 questioning the need for out-of-hours insertion of ICD. Three physician-led elective sessions/week were introduced in November 2008; trainees were directly supervised by experienced physicians (consultants); all unavoidably out-of-hours ICD procedures were reviewed by respiratory consultants. Results: Fifty-two patients underwent ICD insertion in 5 months: 18 (34.62%) for pneumothorax; 34 (65.38%) for effusions. Of the 34 with pleural effusions, 31 (91.17%) had radiological imaging pre-procedure. The 3 (8.82%) who had ICDs without prior radiological imaging were due to suspected empyema thoracis in the emergency department. Only 2 ICDs (3.84%) - both for pneumothoraces - were complicated by infection of the pleural space. No other major complications occurred in the remaining 50 patients. Initial ICD was displaced in 8 patients needing further ICD insertions (15.38%), confirming a significant improvement with respect to the local average. Conclusion: The successful pilot of consultant-led ICD-insertion sessions led to reduced length of stay, improved outcomes and improved trainee feedback - hence our policy recommendation to include pleural procedure sessions in physician job plans which is currently not undertaken uniformly in the UK.