Pulmonary, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
Pulmonary, The University of Tennessee Medical Center, Knoxville, Tennessee, USA.
BMJ Open Qual. 2023 Sep;12(3). doi: 10.1136/bmjoq-2022-002197.
Malignant pleural effusions (MPE) can cause severe dyspnoea leading to greater than 125 000 hospitalisations per year and cost greater than US$5 billion per year in the USA. Timely insertion of tunnelled pleural catheters (TPCs) is associated with fewer inpatient days and emergency department visits. We conducted a quality improvement study to reduce hospital admissions of patients with MPE.
Key stakeholders were surveyed, including thoracic and breast oncology teams, general pulmonary and interventional pulmonology (IP) to help identify the underlying causes and solutions. Our preintervention group consisted of 51 patients who underwent TPC placement by our IP service. In our first intervention, we reviewed referrals for MPE with the scheduling team and triaged them based on urgency. In the second intervention, we added a follow-up phone call 1 week after the initial thoracentesis performed by IP to assess for the recurrence of symptoms.
Demographic and clinical characteristics were summarised across the three groups. We evaluated the rate ratio (RR) of admissions in the intervention groups with the multivariable Poisson regression and adjusted for race, gender and cancer. Compared with the preintervention group, intervention I showed trends towards a 41% lower hospital admission rate (RR 0.59 (0.33-1.07), p=0.11). Compared with the preintervention group, intervention II showed trends towards a 40% lower hospital admission rate (RR 0.6 (0.36-0.99), p=0.07). The results did not reach statistical significance. Exploratory comparisons in readmission rates between interventions I and II showed no difference (RR 0.89 (0.43-1.79), p=0.75).
Both interventions showed trends toward fewer hospital readmissions although they were not statistically significant. Larger-size prospective studies would be needed to demonstrate the continued effectiveness of these interventions.
恶性胸腔积液（MPE）可导致严重呼吸困难，每年导致超过 125000 人次住院，在美国每年花费超过 50 亿美元。及时插入经皮胸膜导管（TPC）可减少住院天数和急诊就诊次数。我们进行了一项质量改进研究，以减少 MPE 患者的住院人数。
对包括胸科和乳腺肿瘤团队、普通肺科和介入肺科（IP）在内的关键利益相关者进行了调查，以帮助确定潜在的原因和解决方案。我们的预干预组包括 51 名由我们的 IP 服务进行 TPC 放置的患者。在我们的第一次干预中，我们与调度团队一起审查了 MPE 的转诊，并根据紧急程度对其进行了分类。在第二次干预中，我们在 IP 进行初始胸腔穿刺后 1 周增加了随访电话，以评估症状是否复发。
在三组中总结了人口统计学和临床特征。我们使用多变量泊松回归评估了干预组的入院率比值（RR），并调整了种族、性别和癌症因素。与预干预组相比，干预 I 显示出住院率降低 41%的趋势（RR 0.59（0.33-1.07），p=0.11）。与预干预组相比，干预 II 显示出住院率降低 40%的趋势（RR 0.6（0.36-0.99），p=0.07）。结果未达到统计学意义。干预 I 和 II 之间的再入院率的探索性比较显示无差异（RR 0.89（0.43-1.79），p=0.75）。
尽管这两种干预措施都显示出住院人数减少的趋势，但没有达到统计学意义。需要更大规模的前瞻性研究来证明这些干预措施的持续有效性。
