Impact Of A Dedicated Specialist Pleural In-Reach Service In A Large Teaching Hospital

Introduction: Increasing burden of pleural diseases has led to the development of comprehensive day-case dedicated pleural services in most centres in the UK over the last decade. We reviewed our 5-day specialist-led in-reach pleural activity in a large teaching hospital. Methods: Consecutive electronic inpatient pleural referrals (October 2017 - June 2019) were reviewed for source, time of referral to review and interventions. Emergency Department & Acute Ambulatory Care referrals reviewed and discharged the same day were excluded. Results: Of 1152 patients reviewed, 607 were in-patient referrals. Mean (range) 72 (18–99) years; female: male 276 (45.5%): 331 (54.5%). Source of referrals: medical wards including short stay 423 (69.7%), surgical wards 97 (16%), oncology 61 (10%), acute medical unit 26 (4.3%). Time of referral to pleural review (see figure 1); 357 (58.8%) were reviewed by the next day. Presentations include effusion 574 (94.6%), pneumothorax 21 (3.5%), hydropneumothorax 12 (2%). 267 (44%) had chest ultrasound only; 229 (37.7%) diagnostic & therapeutic aspiration; 91 (15%) chest drains (insertion/removal); 14 indwelling pleural catheter procedures (insertion/drainage/talc); 3 tru-cut pleural biopsies; 3 no intervention. Conclusion: A specialist pleural in-reach service can streamline the pleural management pathways and should translate into reduced length of stay, timely intervention, early diagnosis & improved outcomes.