Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.
BACKGROUND
In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003.


OBJECTIVE
To determine adherence to the 2003 BTS SP guidelines in a district general hospital.


METHODS
An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed.


RESULTS
Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs.


CONCLUSIONS
Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.
Medford
Andrew Rl
AR
Department of Respiratory Medicine, Taunton and Somerset NHS Trust, Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, UK. andrewmedford@hotmail.com
Pepperell
Justin Ct
JC
D000328:Adult; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011030:Pneumothorax / Q000628:therapy*; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D006113:United Kingdom