Understanding how variation in clinical practice affects length of stay for patients with malignant pleural effusion

Background: Malignant pleural effusion (MPE) is a rising healthcare burden requiring inpatient care. Variation in clinical practice results in prolonged length of stay (LOS) for this vulnerable group where life expectancy is already compromised. Chest tube drainage remains the preferred local treatment with talc pleurodesis being performed as guided by patients’ suitability and preference. An institution-based clinical audit in 2016 revealed a median effusion related LOS of >7 days. This review aims to identify factors contributing to prolonged pleural drainage and implement strategies to improve management of MPE by reducing hospital stay. Methods: We identified factors of delay in chest tube removal from baseline data (n=53) and implemented targeted interventions over 3 months: 1. Spreading the word to stakeholders (Respiratory Medicine, Palliative Medicine, General Medicine, Radiology) involved; 2. Collaboration with Pathology/molecular laboratory for timely reporting of results; 3. Regular reminder and education of clinical staff regarding evidence-based practice; 4. Implementation of a practical guide/checklist for chest tube management and talc pleurodesis; 5. Talc pleurodesis Procedure Information Sheet. Results: The data of 61 patients during and post intervention between 1 Jun 2017 and 28 Feb 2018 was analysed. Median effusion related LOS decreased from >7 to 5 days. This improvement continued to sustain 6 months after implementation of all interventions. Conclusion: Through education and collaborative efforts in building partnerships, we achieved success in improving management of MPE and reducing effusion related LOS whilst maintaining quality care.