Change in the practice of insertion of chest drains from 2008 to 2015 in a UK district general hospital

Abstract

Introduction: There has been a momentous change in the UK practice of chest drain insertion following publication of the 2010 British Thoracic Society (BTS) pleural disease guidelines. 1 This change has been supplemented by repeated national audits for hospitals to improve the training of doctors and reduce complication rates. Aims: To compare the practice of chest drain insertion in patients with pleural effusion and pneumothorax before and after the introduction of formal clinical skills training in 2010 and bedside thoracic ultrasound in 2014. Method: One hundred chest drain insertions from 2008 to 2009 were retrospectively compared with 69 procedures from 2014 to 2015. Procedure consent, ultrasound, timing, supervision, complications, speciality, grade of doctor and duration of drainage were audited from patients9 notes and imaging reporting systems according to BTS standards. Results: A positive response to the safe guidance of inserting chest drains after 2010 is implied. Conclusion: There has been a fundamental shift towards ultrasound guidance, specialist senior involvement and limitation of out of hours9 insertion of chest drains. Further training in bedside ultrasound and written consent will be re-audited.