title: Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.
abstract: OBJECTIVE
  Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety.
  
  
  METHODS
  We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency.
  
  
  RESULTS
  The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114.
  
  
  CONCLUSIONS
  Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.
authors.affiliation: Department of Thoracic Surgery,  St James's University Hospital, Leeds,  UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Tcherveniakov
authors.forename: Jonathan
authors.initials: J
authors.lastname: De Siqueira
authors.forename: Richard
authors.initials: R
authors.lastname: Milton
authors.forename: Kostas
authors.initials: K
authors.lastname: Papagiannopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D003362:Cost-Benefit Analysis; D020878:Device Removal; D004322:Drainage / Q000009:adverse effects / Q000191:economics / Q000451:nursing*; D004739:England; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000458:organization & administration*; D011030:Pneumothorax / Q000209:etiology / Q000451:nursing / Q000628:therapy; D011182:Postoperative Care / Q000191:economics / Q000451:nursing; D011184:Postoperative Period; D057184:Practice Patterns, Nurses' / Q000191:economics / Q000458:organization & administration*; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult