title: Bedside pleural procedures by pulmonologists and non-pulmonologists: a 3-year safety audit.
abstract: OBJECTIVE
  Pleural procedures such as tube thoracostomy and chest aspirations are commonly performed and carry potential risks of visceral organ injury, pneumothorax and bleeding. In this context limited information exists on the complication rates when non-pulmonologists perform ultrasound-guided bedside pleural procedures. Bedside pleural procedures in our university hospital were audited to compare complication rates between pulmonologists and non-pulmonologists.
  
  
  METHODS
  A combined safety approach using standardized training, pleural safety checklists and ultrasound-guidance was initially implemented in a ∼1000-bed academic medical centre. A prospective audit, over approximately 3.5 years, of all bedside pleural procedures excluding procedures done in operating theatres and radiological suites was then performed.
  
  
  RESULTS
  Overall, 529 procedures (295 by pulmonologists; 234 by non-pulmonologists) for 443 patients were assessed. There were 16 (3.0%) procedure-related complications, all in separate patients. These included five iatrogenic pneumothoraces, four dry taps, four malpositioned chest tubes, two significant chest wall bleeds and one iatrogenic hemothorax. There were no differences in complication rates between pulmonologists and non-pulmonologists. Presence of chronic obstructive pulmonary disease (COPD) independently increased the risk of complications by nearly sevenfold.
  
  
  CONCLUSIONS
  Results from this study support pleural procedural practice by both pulmonologists and non-pulmonologists in an academic medical centre setting. This is possible with a standard training program, pleural safety checklists and relatively high utilization rates of ultrasound guidance for pleural effusions. Nonetheless, additional vigilance is needed when patients with COPD undergo pleural procedures.
authors: Division of Respiratory and Critical Care Medicine, National University Health System, University Medicine Cluster, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors: Kay Choong
authors: KC
authors: See
authors: Venetia
authors: V
authors: Ong
authors: Chia Meng
authors: CM
authors: Teoh
authors: Oon Cheong
authors: OC
authors: Ooi
authors: Louis Sutrisno
authors: LS
authors: Widjaja
authors: Sandhya
authors: S
authors: Mujumdar
authors: Jason
authors: J
authors: Phua
authors: Kay Leong
authors: KL
authors: Khoo
authors: Pyng
authors: P
authors: Lee
authors: Tow Keang
authors: TK
authors: Lim
mesh_terms: D000368:Aged; D057189:Checklist; D015505:Chest Tubes; D054869:Clinical Audit; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education*; D012307:Risk Factors; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: checklist; patient safety; pleura; thoracostomy; ultrasonography