Potential bed-day savings in patients admitted unnecessarily for pleural invesigation

Abstract

Introduction: Pleural effusions commonly present as emergency hospital admissions. Our aim was to identify what proportion of admissions could be avoided by upscaling ambulatory diagnostic pleural services, including use of a responsive pleural nurse specialist and hot-clinic activity. Methods: We retrospectively reviewed all pleural aspirations between 1.8.17 – 28.2.18 at our unit. Reason for admission and length of stay (LoS) were recorded. Results: 80% (149/187) of cases were emergency admissions, 6% (11/187) elective admissions, 14% (27/187) outpatient day cases. Mean age was 69 (SD 14). 57% (n=107) had malignant pleural effusion (MPE), 28% (n=52) pleural infection and 15% (n=28) other benign effusion. In emergency admissions, median LoS was 17 (IQR 10 – 28) days and median time to pleural aspiration was 3 (IQR 1 – 8) days. Reasons for admission are summarised in Table 1. Avoidable admissions (investigation of effusion only (32/149 (21%)) accounted for 425 bed days (median LoS of 11 (IQR 6 - 20) days). The majority of these cases (28/32 (87.5%)) had MPE. Conclusion: Emergency admission with pleural effusion is common and often prolonged. In this hospital-wide cohort, 21% of admissions could potentially have been avoided if the current ambulatory pleural service was upscaled. Most avoidable admissions were in patients with MPE, who often have a poor prognosis. Minimising such admissions is therefore vitally important.