Authors (including presenting author) :
KY Chiang 1, SC Lip 1, FKP Chan1, JKC Leung1, WC Kwok 1, TCC Tam1, KF Cheng1, MS Lui 1
Affiliation :
1 Division of Respiratory Medicine, Department of Medicine, QMH
Introduction :
Pleural effusion and pneumothorax are common medical problems. Ultrasound guidance is an established standard of care for pleural procedures for improving procedural safety and outcomes. Logistics of transferring multi-morbid patients to ultrasound department pose demand on the porter service, elevator utilization and are associated with risks of patient transfer.
Objectives :
To assess the feasibility of a mobile service model for safe and timely chest drain insertion under physician-based ultrasound guidance for patients who required chest drainage for pleural effusions or pneumothoraces.
Methodology :
The respiratory physicians led a pilot outreach service of bedside chest drain insertion under ultrasound guidance, for patients who required chest drains in general medical wards of Department of Medicine, Queen Mary Hospital from August 2020– July 2021. Records were retrieved from Clinical Data Analysis and Reporting system and dates of admissions/referral, investigation booking and procedures were recorded. Outcomes and waiting time for chest drain placement were analyzed and compared.
Result & Outcome :
Result
During the 1-year period, 159 episodes of chest drain insertion were recorded in general medical wards in Queen Mary Hospital. Chest drains inserted by the emergency department (n=14) or by thoracic surgeons (n=1) were excluded. Seventy-eight percent of the episodes were emergency admissions. Eighty-eight percent (n=126) of the drainages were for pleural effusions and the rest were pneumothoraces. There were 71 males (49%), with median age of 68 (IQR 60-77). Majority of the patients (79%) had at least 2 or more major co-morbidities (including cardiac, renal, respiratory diseases or underlying malignancies).
53 (37%) chest drains were inserted by physicians under ultrasound guidance, and 91 (63%) chest drains were inserted at the radiology department. Mean waiting time from referral to chest drain insertion were 0.6 days and 6.6 days in the groups performed by physicians and radiologists respectively (p< 0.001). For chest drain insertion performed within 2 days of request, it was achieved more commonly among physicians when compared with radiologists (96% vs 56%, p< 0.001). There were no major procedure-related complications reported.
Conclusion
Mobile service for chest drain insertion under physician-based ultrasound guidance is effective and safe. While patients could receive more timely symptomatic relief and potentially shorten hospitalization duration, the risks associated with patient transfer, elevator utilization, porter and space stress could also be mitigated by the new approach.
