title: Differential implementation of special society pleural guidelines according to craft-group: impetus toward cross-specialty guidelines?
abstract: We examined the effects of a programme to improve adherence to British Thoracic Society pleural procedure guidelines at our institution. Following a baseline audit, we performed an intervention to enhance adherence to these guidelines. We then performed a postintervention audit. At baseline, there were different levels of guideline adherence depending on the specialty of the clinician inserting chest tubes. Interventions to improve adherence were hampered by limited access to non-respiratory teams. Thus, improvements in response to intervention were also specialty specific. Overall, procedures performed by respiratory medicine had higher adherence rates compared with those performed by non-respiratory teams. We concluded that guidelines promoted at a local level by one specialty have limited traction on members of another specialty. For pleural procedures, which cross specialty boundaries, we propose that future guidelines be developed jointly by all relevant specialties. This could facilitate unified guideline implementation at the clinical coalface.
authors.affiliation: Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lafontaine
authors.affiliation: Monash Lung & Sleep, Monash Health, Clayton, Australia drjoosten@hotmail.com.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Joosten
authors.affiliation: Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Steinfort
authors.affiliation: Royal Melbourne Hospital, Parkville, Australia.
authors.forename: Louis
authors.initials: L
authors.lastname: Irving
authors.affiliation: Alfred Hospital, Melbourne, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Hew
mesh_terms: D015505:Chest Tubes; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D008511:Medicine; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine / Q000592:standards; D012955:Societies, Medical; D006113:United Kingdom
keywords: Pleural disease; chest tube insertion; pleural intervention
references.citation: Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416
references.pmid: 17277290
references.citation: Postgrad Med J. 2010 Feb;86(1012):68-72
references.pmid: 20145053
references.citation: Thorax. 2011 Jul;66(7):636-7
references.pmid: 21474495
references.citation: Thorax. 2010 Aug;65 Suppl 2:ii61-76
references.pmid: 20696688
references.citation: Intern Med J. 2014 Jan;44(1):50-6
references.pmid: 24112296
references.citation: Thorax. 2010 Aug;65 Suppl 2:ii1-3
references.pmid: 20696689
references.citation: Chest. 2010 Mar;137(3):536-43
references.pmid: 19820073
references.citation: Intern Med J. 2008 Dec;38(12):887-91
references.pmid: 18284460