PURPOSE: Appropriate and timely management of a parapneumonic effusion (PPE) is important. The aim of this study was to develop a set of applicable quality indicators (QI) to assess the evaluation and management of PPE in hospitalized patients with community-acquired pneumonia (CAP).
METHODS: A multidisciplinary panel of 7 infectious diseases and pulmonary specialists from the University of Louisville completed the following three-step process: 1) developed flowcharts illustrating clinical pathways in the evaluation and management of PPE; 2) developed process-of-care quality indicators (QI); 3) developed outcome-based quality indicators. Finally, the flowcharts and QIs were tested in a sample of patients.
RESULTS: Four QIs were selected. QI 1: Timely evaluation of pleural space anatomy (EPSA) performed within 48 hours of admission (by either postero-anterior & lateral chest radiograph, lateral decubitus chest film, or CT of the chest). QI 2: Timely diagnostic thoracentesis performed within 24 hours of indication. QI 3: Timely therapeutic drainage of pleural effusion performed within 48 hours of indication (by either serial thoracentesis, small bore catheter, full-size chest tube, VATS or thoracotomy). QI 4: Successful resolution of PPE at 30 day followup. Failure was defined as: a) no change or an increase in size of effusion, b) need for re-drainage, c) or evidence of peel formation.
CONCLUSION: A systematic approach was used to develop a set of QIs to assess physicians' evaluation and management of PPE. Our initial experience at the University of Louisville suggests that these locally developed QIs can be helpful in the evaluation and management of hospitalized patients with CAP and PPE.
CLINICAL IMPLICATIONS: Further studies using these QIs may improve the quality of care provided to hospitalized patients with CAP and PPE.
DISCLOSURE: Ervin Anaya, No Financial Disclosure Information; No Product/Research Disclosure Information