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• W2891077385 abstract "Pleural disease is increasing in frequency and is associated with more specialist evidence-based treatments. Over the last 5 years, the Oxford Pleural Unit has operated a pleural on-call service by instituting the provision of a pleural phone and e-mail service as a central point of contact for pleural-related questions, internally for the hospital trust, and externally for local general practitioners and district nurses. The phone is held during working hours, and the e-mail service is monitored daily by a member of the pleural team (consultants or pleural fellows). To assess the activity, impact, and outcomes from the on-call service, received phone calls logged onto a datasheet were analyzed. This represents an underestimation because some cases were directly recorded onto the patient electronic record and were not analyzable for this study. All documented datasheet pleural phone referrals and e-mail referrals (March 2016-February 2017) were analyzed retrospectively. The number of cases discussed via e-mail is not a reflection of the number of e-mails because each case may have involved several e-mails over a number of days. Outcomes avoided were defined as clearly documented changes in the referral team’s management plan, as a result of referral, which led to avoidance of unnecessary outcomes. There were 506 cases discussed (e-mail: n = 257, phone: n = 249), with a mean of 1.9 referrals per working day. The reasons for, and outcomes of, referrals are shown in Tables 1 and 2, respectively. Outcomes such as unnecessary hospitalization or impact on length of stay were not measurable in this analysis.Table 1Reasons and Numbers of Referrals to the Pleural On-Call Service (N = 506)Reason for ReferralPercentage of Total Referrals (No.)Pleural effusion (new or known)66.8 (338)Empyema (diagnosed or suspected)8.3 (42)Pneumothorax6.5 (33)Indwelling pleural catheter-related queries5.1 (26)Other (eg, pleurodesis-related)13.2 (67) Open table in a new tab Table 2Outcomes, Including Unnecessary Outcomes Avoided, of Referrals to the Pleural On-Call Service (N = 506)Outcome of ReferralPercentage of Total Referrals (No.)Advice given33.6 (170)Advice and pleural clinic follow-up23.7 (120)Advice and scheduling of pleural procedure42.7 (216) • Pleural one stop shop for both procedure and review13.4 (29) • Procedure by the pleural team49.1 (106, including those scheduled for pleural one stop shop [n = 29]) • Procedure by the radiology team49.1 (106) • Initial procedure by the radiology team (pleural fluid aspiration) then a further procedure by the pleural team (indwelling pleural catheter insertion: n = 2, medical thoracoscopy: n = 1)1.4 (3) • Bronchoscopy0.5 (1)Unnecessary outcome avoided4.3 (22) • Unnecessary pleural procedures22.7 (5) • Unnecessary clinic visits72.7 (16)- Pleural follow-up visit (n = 10)- Pleural new case visit (n = 4)- Other specialties clinic visit (n = 2) • Unnecessary CT scan4.5 (1) Open table in a new tab The benefits of a dedicated specialized pleural service are well recognized and improve safety and reduce hospital length of stay.1Bhatnagar R. Maskell N. Developing a ‘pleural team’ to run a reactive pleural service.Clin Med. 2013; 13: 452-456Crossref PubMed Scopus (22) Google Scholar, 2Aujayeb A. Parker S. Bourke S. Miller J. Cooper D. A review of a pleural service.J R Coll Physicians Edinb. 2016; 46: 26-31Crossref PubMed Scopus (13) Google Scholar, 3Hopper C.E. Lee Y.C. Maskell N.A. Setting up a specialist pleural disease service.Respirology. 2010; 15: 1028-1036Crossref PubMed Scopus (41) Google Scholar Patients with pleural disease are frequently cared for by different specialties, such as general medicine and oncology, without specific expertise in pleural disease. A pleural on-call service revolutionizes and facilitates the pleural service delivery, facilitates access to the service, and simplifies the referral and triaging pathways. Research-active institutions are associated with the delivery of better care for patients.4Downing A. Morris E.J. Corrigan N. et al.High hospital research participation and improved colorectal cancer survival outcomes: a population-based study.Gut. 2017; 66: 89-96Crossref PubMed Scopus (74) Google Scholar In addition to facilitating the delivery of appropriate pleural disease management, the pleural on-call service facilitates involvement of patients in research trials because the pleural team who delivers this service is also involved in the running of pleural clinical trials. Delivery of an on-call pleural service is feasible and beneficial to both patients and hospital services. Although doctors run the pleural on-call service in our hospital trust, suitably trained pleural nurses would be capable of running such a service." @default.
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• W2891077385 date "2018-09-01" @default.
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• W2891077385 title "Activity and Outcomes From a Dedicated Pleural On-Call Service" @default.
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• W2891077385 doi "https://doi.org/10.1016/j.chest.2018.05.027" @default.
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