Pulmonary Medicine / 2018 / Article / Tab 1

Research Article

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).

CharacteristicsResults

Age at evaluation63 (56–75)
 Median (IQR)—yr.
Female sex—no. (%)15 (40.5)
—no.54
Initial consult location—no. (%)
 Emergency department12 (22.2)
 Outpatient20 (37)
 Inpatient22 (40.7)
Consults with documented follow up—no. (%)47 (87)
Ultrasound examinations—no.55
Primary pleural diagnosis—no.40
 Primary spontaneous pneumothorax3
 Secondary spontaneous pneumothorax5
 Traumatic pneumothorax4
 Noninfectious and nonmalignant exudative effusions7
3
 Paramalignant effusion4
 Malignant pleural effusion5
 Transudate effusions5
 Others (giant bullae, indwelling IPC s/p pleurodesis, normal pleural ultrasound exam)4
Pleural procedures—no.60
 8 F chest tube insertionπ6
 14 F chest tube insertion4
 >14 F chest tube insertion8
 Thoracentesis26
 Indwelling pleural catheter (IPC) insertion3
 IPC 1
 Pleuroscopy (with and without pleural biopsy)3
 IBV® valve insertionß3
 VATS assisted bleb 3
 Surgical decortication3
Complications—no.14
 Pain during fluid drainage5
 Iatrogenic 2
 ER evaluation due to patient concerns§2
 Chest drain 3
 IPC track metastasis1
 Subcutaneous emphysema1

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.