Inception of a pleural clinic at a metropolitan health service.

Abstract

Introduction/Aim: Pleural disease is common and constitutes a significant proportion of referrals received by every respiratory unit. An evidence-based paradigm shift towards an ambulatory model of care for pleural disease has seen the establishment of specialised pleural clinics in multiple centres. We undertook an audit to describe the caseload of a recently conceived outpatient pleural clinic at a Victorian tertiary metropolitan health service. Method(s): An audit of the weekly pleural clinic at Monash Health (a tertiary referral centre) was performed between its inception on 1 March 2022 till 30 June 2022. Data was collected prospectively from administrative and electronic medical records. Source of referral, diagnosis, use of point of care ultrasound, need for pleurocentesis, and procedural complications were evaluated. Comparative data was retrospectively retrieved from hospital coding records. Result(s): Between March 2022 and June 2022, a total of 59 patients were referred to our pleural clinic, of which 50 patients attended. Most referrals came from the emergency department (n = 18) and inpatient respiratory consults team (n = 14) following admission. Attendance was for either an initial work-up (n = 22) or follow-up (n = 28). The most common diagnosis was primary spontaneous pneumothorax (n = 8) followed by known malignant pleural effusion (n = 5) and congestive cardiac failure (n = 5). 24 patients had further assessment with point-of-care ultrasound and 9 patients underwent pleurocentesis with no immediate procedural complications. 8 patients reviewed expeditiously post-inpatient admission for pleural effusion had a mean length of stay (LOS) of 4.4 days, a reduction of 8.1 days from mean LOS of the same time period the year prior to clinic conception. Conclusion(s): Pleural disorders have a high incidence and wide spectrum of disease. A specialized pleural clinic may provide expertise in managing these conditions in a safe and timely manner and is an important cog in developing a pleural service with an ambulatory model of care.