Systemwide Implementation of a Multidisciplinary Clinical Pathway for Malignant Pleural Effusion Reduces...

Malignant pleural effusion (MPE) adversely impacts quality of life (QOL), carrying a significant health care burden and inpatient mortality. We hypothesize that multi-specialty management leads to nonstandardized approaches resulting in fragmented, inefficient and costly care. We aimed to design, implement, and evaluate a system-wide clinical pathway for MPE management to streamline care, reduce emergency visits, hospitalizations, pleural interventions and improve cost efficiency.

We conducted a single-center study evaluating outcomes before and after pathway implementation. The pathway was developed through a multidisciplinary team (interventional pulmonology, thoracic surgery, oncology, emergency medicine, hospital medicine, and nurse navigation) using survey-driven gap analysis. Standardized workflows were integrated into the electronic medical record (EMR) system to enable early identification, direct triage, and expedited ambulatory pleural procedures. Pathway variations were tailored for inpatient, outpatient oncology, primary care, and surgical referrals. Patients were divided into 3 groups: a prepathway control cohort, an early postpathway cohort 1, and a late postpathway cohort 2 to assess both immediate and sustained impacts.

Implementation of the MPE pathway significantly reduced ER visits (control vs. cohort 1: 80 vs. 43, P = 0.0051; cohort 1 vs. cohort 2: 43 vs. 25, P = 0.028) and hospitalizations (71 vs. 37, P = 0.0046; 37 vs. 21, P = 0.021). Cost analysis showed average savings of $1145 per patient in direct variable ER and inpatient costs. The pathway also reduced pleural procedures and specialist involvement.

Centralized, protocolized care for MPE improves outcomes, reduces health care utilization and generates cost savings. Broader adoption may enhance QOL and efficiency in patients with advanced malignancies.