Outcomes of a Clinical Pathway for Pleural Disease Management: “Pleural Pathway”

Table 1

Key findings from the audit during the pathway era (from August 1, 2014, to July 31, 2015).

Characteristics	Results
Age at evaluation	63 (56–75)
Median (IQR)—yr.
Female sex—no. (%)	15 (40.5)
—no.	54
Initial consult location—no. (%)
Emergency department	12 (22.2)
Outpatient	20 (37)
Inpatient	22 (40.7)
Consults with documented follow up—no. (%)	47 (87)
Ultrasound examinations—no.	55
Primary pleural diagnosis—no.	40
Primary spontaneous pneumothorax	3
Secondary spontaneous pneumothorax	5
Traumatic pneumothorax	4
Noninfectious and nonmalignant exudative effusions	7
	3
Paramalignant effusion	4
Malignant pleural effusion	5
Transudate effusions	5
Others (giant bullae, indwelling IPC s/p pleurodesis, normal pleural ultrasound exam)	4
Pleural procedures—no.	60
8 F chest tube insertion^π	6
14 F chest tube insertion	4
>14 F chest tube insertion^†	8
Thoracentesis	26
Indwelling pleural catheter (IPC) insertion	3
IPC	1
Pleuroscopy (with and without pleural biopsy)	3
IBV® valve insertion^ß	3
VATS assisted bleb	3
Surgical decortication	3
Complications—no.	14
Pain during fluid drainage	5
Iatrogenic	2
ER evaluation due to patient concerns^§	2
Chest drain	3
IPC track metastasis	1
Subcutaneous emphysema	1

patients had more than one unique consult due to recurrent disease on the same or contralateral side. There were 37 unique patients in the audit. These patients received initial fibrinolytic treatment (tPA + DNase). ^π8 F tube with an inbuilt Heimlich valve apparatus. ^†Two insertions were in the setting of secondary spontaneous pneumothoraces with acute respiratory failure and one insertion to palliate a concurrent large pleural effusion and an iatrogenic pneumothorax. Five insertions were in the postoperative setting; ^ΩRemoved in the ER (after pleurodesis confirmation) in the context of a Health Information Exchange alert about multiple area ER visits for a “nonfunctional catheter.” ^ßIBV Valve (Spiration, Redmond, WA, USA) is a unidirectional valve that blocks air entry distally and is inserted via a bronchoscopic procedure. In our series, all of them were inserted in prolonged air leaks due to secondary spontaneous pneumothoraces. Video assisted thoracoscopy. One of the episodes required an ambulatory 8 F chest tube. 2nd episode required hospital admission due to lack of credible follow-up. ^§Emergency room evaluation related to patient concerned about serosanguinous discharge into the ambulatory 8 F chest tube. ^‡None of the dislodged chest tubes required reinsertion.