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Editorials |

Procedural Risks in Thoracentesis: Process, Progress, and Proficiency

David M. Gaba, MD; William F. Dunn, MD, FCCP
Author and Funding Information

Correspondence to: William F. Dunn, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: dunn.william@mayo.edu


Dr. Gaba is Associate Dean for Immersive and Simulation-based Learning at Stanford University School of Medicine and is the Editor-in-Chief of Simulation in Healthcare, the official journal of the Society for Simulation in Healthcare.

Dr. Dunn is a Consultant in the Division of Pulmonary and Critical Care Medicine at Mayo Clinic Rochester and is Medical Director of the Mayo Clinic Multidisciplinary Simulation Center. He is the former Program Director of the Mayo Clinic Multidisciplinary Critical Care Fellowship and is the Immediate Past President of the Society for Simulation in Healthcare.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1120-1123. doi:10.1378/chest.09-0306
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Extract

Two aims of increasing importance in clinical and quality management are identifying areas of iatrogenic risk and improving patient safety. In this issue of CHEST (see page 1315), Duncan et al2 describe a complex and comprehensive intervention performed by personnel in an academic pulmonary medicine group practice that is designed to reduce the risk of pneumothorax after outpatient thoracenteses. The authors emphasize the component of the intervention that uses experiential training in a zero-risk (simulation) environment. Simulation-based experiential learning was an important part of their intervention. We would submit, however, that this study is much more complicated than just a “training story.” We believe that one of the important lessons of the article by Duncan and colleagues2 is that training alone is rarely enough; it is system analysis and process change, reinforced by intensive training and changes in medical culture, that really are the linchpins of the safest clinical practices and process improvements in health care.

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