Quality Improvement Initiatives for Pleural Infection Managed with Intrapleural Therapy.

Area of Science:

• Pulmonology
• Critical Care Medicine
• Healthcare Quality Improvement

Background:

• Pleural infection management is complex and associated with high mortality.
• Care-process metrics like management delays and therapy administration are crucial but often overlooked.
• Audits identified significant gaps in pleural infection care processes at our institution.

Purpose of the Study:

• To evaluate the impact of implementing quality improvement initiatives on adult pleural effusion management.
• To assess changes in both clinical outcomes and care-process metrics following interventions.

Main Methods:

• Retrospective comparison of patients treated for pleural infection before (2013-2016) and after (2020-2021) quality improvement interventions.
• Interventions included new policies for pleural drainage and intrapleural therapy, nurse administration of therapy, and updated guidelines.
• Key outcomes measured were length of stay, mortality, surgical treatment, and care-process metrics.

Main Results:

• Surgical management incidence decreased from 14% to 0% (P=0.01).
• Use of smaller drains (<12 F) decreased significantly (51% to 7%, P<0.001), and drain blockage reduced (20% to 2%, P=0.004).
• Intrapleural therapy administration improved, with better protocol adherence and fewer missed doses; nurse administration increased to 70%.

Conclusions:

• Multifaceted quality improvement initiatives enhanced intrapleural therapy administration and chest drainage practices for pleural infection.
• The interventions led to a significant reduction in the need for surgical intervention.
• Hospital length of stay, mortality, and management delays were not significantly affected by the implemented changes.