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Time Utilization of Ultrasound Guided Thoracentesis at a Tertiary Care Center FREE TO VIEW

Dhruv Joshi, MD; Francisco Almeida; Joseph Cicenia; Michael Machuzak; Atul Mehta; Sonali Sethi; Thomas Gildea
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Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):534A. doi:10.1378/chest.1993832
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SESSION TITLE: Quality & Clinical Improvement Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Thoracentesis is a common medical procedure. Several hospitals employ dedicated services supervised by physicians experienced in use of chest ultrasonography and performance of thoracenteses. This expedites performance, minimizes complications and maintains quality. Despite this, thoracentesis can be challenging, associated with complications and requires utilization of significant resources. Our retrospective analysis looks at time utilized for performance of thoracenteses by a specialized pleural service at a tertiary care center over 1 year.

METHODS: 269 thoracenteses were performed by the pleural service (8 pulmonologists trained in chest ultrasonography) at the Cleveland Clinic in 2012. Procedures referred by inpatient and outpatient services were performed in a dedicated procedure room with nurse support. Procedures were done with intent of symptoms limited complete drainage. Procedures were performed with Arrow-Clarke™ Pleura-Seal® Thoracentesis Kit (n=135), Carefusion Safe-T-Centesis (n=106) or other kits (i.e., Cook catheter, angiocatheter, etc. (n=28)). We recorded the time patient entered the room, the time physician initiated the procedure and the time patients left the room after assessment for complications and approval for discharge by the physician. The physician’s ‘hands on time’ was time from procedure initiation to the time patients left the room.

RESULTS: Mean and median total time spent in the room by patients was 63 and 71 minutes (SD +/- 28min; Range 15-205min). Mean and median time from procedure start to catheter out was 36 and 25 minutes (SD +/- 24min). Mean and median total physicians’ ‘hands on time’ was 50 and 45 minutes (SD +/- 26min). This included post procedure assessment, documentation and in event of symptoms or complications reassessing patients and approving for discharge. Mean and median time from procedure completion to approving patients for discharge was 14 and 8 minutes (SD+/- 15min). Average procedure time is 57% of the total time.

CONCLUSIONS: Thoracenteses at tertiary care centers requires significant utilization of resources. We have shown that even in a setting with a trained procedure nurse, a dedicated procedure room with expedient availability of equipment, trained pulmonologists who are experienced in the use of ultrasounds spend a significant amount of time performing this procedure.

CLINICAL IMPLICATIONS: Our study shows that even in ideal settings a significant amount of time performing this procedure with wide variations should be expected.

DISCLOSURE: The following authors have nothing to disclose: Dhruv Joshi, Francisco Almeida, Joseph Cicenia, Michael Machuzak, Atul Mehta, Sonali Sethi, Thomas Gildea

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