Related Experiment Video
Updated: Jan 10, 2026
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Systemwide Implementation of a Multidisciplinary Clinical Pathway for Malignant Pleural Effusion Reduces
Ismael Matus1, Vamsi Krishna Matta2, Jacqueline Pellenbarg1
1Thoracic Surgery and Interventional Pulmonology Service, Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System.
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
Insights
Implementing a clinical pathway for malignant pleural effusion (MPE) significantly reduced emergency visits and hospitalizations. This standardized approach to MPE management improves efficiency and lowers healthcare costs.
Area of Science:
- Pulmonology
- Oncology
- Healthcare Management
Background:
- Malignant pleural effusion (MPE) negatively impacts patient quality of life (QOL) and incurs substantial healthcare costs.
- Fragmented, multi-specialty management of MPE can lead to inefficient and costly care.
- A standardized clinical pathway is needed to streamline MPE management.
Purpose of the Study:
- To design, implement, and evaluate a system-wide clinical pathway for malignant pleural effusion (MPE).
- To streamline MPE care, reduce emergency visits, hospitalizations, and pleural interventions.
- To improve the cost-efficiency of MPE management.
Main Methods:
- A single-center study compared outcomes before and after the implementation of a multidisciplinary MPE clinical pathway.
- Standardized workflows were integrated into the electronic medical record (EMR) for early identification and triage.
- Patients were analyzed in three cohorts: pre-pathway, early post-pathway, and late post-pathway.
Main Results:
- The MPE pathway significantly reduced emergency room visits and hospitalizations.
- Cost analysis revealed average savings of $1145 per patient in direct variable costs.
- The pathway also decreased the need for pleural procedures and specialist consultations.
Conclusions:
- Centralized, protocolized care for MPE improves patient outcomes and reduces healthcare utilization.
- The MPE clinical pathway demonstrates significant cost savings.
- Wider adoption of this pathway could enhance QOL and efficiency for patients with advanced malignancies.
Related Concept Videos
01:28Pleural Effusion II: Symptoms and Management
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
01:25Pleural Effusion I: Introduction
There are two main types of pleural effusion: transudative and exudative. They are differentiated using Light's...
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...