Thoracic ultrasound for pleural effusion: delays and cost associated with departmental scanning

Pleural effusion is a common clinical condition on medical wards and the majority of cases undergo pleural aspiration or chest drain insertion as a diagnostic or therapeutic procedure. The use of a thoracic ultrasound scan (USS) improves diagnostic yield for pleural fluid aspiration and reduces complications and USS is increasingly recommended prior to all pleural aspirations or drains and 'real time' scanning which, as well as potentially reducing delays, enhances the safety of the procedure. In many U.K hospitals a thoracic USS is still routinely performed in the radiology department. We reviewed radiology records and case notes from hospital in-patients to assess potential delays and associated costs with departmental thoracic USS and to identify cases where physician-led portable USS would potentially have improved the patient's journey. We demonstrated delays resulting in significant financial costs to the hospital of an estimated pound17, 880 per annum. However, the cost to the patient is also significant, both in terms of patient experience (many of whom will have an underlying diagnosis of metastatic carcinoma and with a limited life expectancy) but also patient safety. Respiratory physicians are increasingly recognising the importance of portable thoracic USS to guide pleural procedures and there has been increasing use of physician-led portable thoracic USS. Hospitals should be encouraged to fund both portable thoracic USS equipment but it is also crucial that training in this area is properly supported.