Outcomes of an initiative to improve inpatient safety of small bore thoracostomy tube insertion

• Published in: Internal medicine journal 2019-05, Vol.49 (5), p.644-649
• Main Authors: Santos, Conceição, Gupta, Saurabh, Baraket, Melissa, Collett, Peter J., Xuan, Wei, Williamson, Jonathan P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chest Tubes - adverse effects; Chest Tubes - standards; Clinical Audit - methods; Clinical Audit - standards; complication; Documentation; Female; Hospitalization; Humans; intercostal thoracostomy tube; Male; Middle Aged; New South Wales - epidemiology; Original; Patient Safety - standards; Pneumothorax; Pneumothorax - diagnosis; Pneumothorax - epidemiology; Pneumothorax - prevention & control; Prospective Studies; Quality control; quality improvement; Quality Improvement - standards; Retrospective Studies; Reviews; thoracic ultrasound; Thoracostomy - adverse effects; Thoracostomy - standards; Thorax; Treatment Outcome; Ultrasound; Viscera; Young Adult
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.14110

Background Intercostal chest catheter (ICC) insertion is a common hospital procedure with attendant risks including life‐threatening complications such as pneumothorax and visceral damage. Aim To investigate the effect of a quality improvement (QI) initiative on complications associated with inpatient thoracostomy tube insertion. Methods Following an audit of ICC complications in inpatients over a 2‐year period we implemented a comprehensive QI programme. This involved formal training in and mandatory use of thoracic ultrasound, standardisation of the procedure and documentation, a dedicated procedure room with nurses trained in assisting ICC insertion and senior supervision for medical staff. An audit over 2 years post‐implementation of the QI protocol was compared with pre‐implementation results. Results A total of 103 cases were reviewed pre‐implementation and 105 cases were reviewed post‐implementation of the QI programme. All procedures following the QI initiative were image guided compared to 23.3% of cases pre‐implementation. The rate of developing a pneumothorax requiring intervention post‐implementation was less than pre‐implementation (1.9% vs 5.8% (P = 0.023). Post‐implementation, there were no instances of dry taps, viscera perforation, clinically significant bleeding or wrong side ICC insertion and documentation improved. Conclusion QI initiative applied to thoracostomy tube insertion in hospital inpatients can reduce complications and improve procedure documentation.