A Shared Aspiration is a review of the quality of care provided to adults who underwent a chest drain insertion or pleural aspiration, of which over 30,000 are undertaken in the UK every year. This review primarily focused on procedures that treat the build-up of fluid between the lung and the chest wall, and that treat air leaking into the pleural space causing the lung to partially or completely collapse.
This study identified variation in all aspects of the intervention and aftercare, including access to specialist pleural teams
Although the vast majority of procedures are performed safely, these are invasive procedures with the potential for serious complications. This study identified variation in all aspects of intervention and aftercare, including access to specialist pleural teams. It found that:
- With better decision-making, 14.6% patients could have had a less invasive approach
- There were opportunities to improve care, and the subsequent pathway prior to admission, for 12.1% patients
- Written consent was documented in only 55.8% cases; use of procedure-specific consent forms was limited, being present in only 39.3% hospitals
- Only 35.8% hospitals had an escalation protocol for complex or high-risk patients out of hours
- Procedure safety checklists (LocSSIPs) were only documented in 34.6% of cases reviewed
- 24.1% patients had no documented post-procedure plan and, where there was one, important elements including drainage targets, monitoring plans and pain management were frequently omitted.
With recommendations for improvement, the report notes that the use of minimum standards, including a procedure-specific consent form, safety checklist and proforma for post-procedure monitoring, are associated with better consent, better pain management and better quality of care in general. Agreeing and using these standards would be relatively straightforward and inexpensive, and would help address many of the variations in care identified.
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