Reducing length of stay through the use of ambulatory chest drains and nurse-led follow-up

Abstract

This paper explores the use of ambulatory chest drains to promote earlier discharge. The insertion of an underwater seal chest drain is routine following thoracic surgical intervention to facilitate post operative lung expansion. This generally takes between 3-5 days. Once the lung has expanded, the drain is removed and the patient discharged. In a minority of patients, namely those with a persistent air leak, recurrent malignant pleural effusion or empyema, lung expansion is slow and consequently discharge is delayed. Many of these patients are able to tolerate an ambulatory device such as the Portex bag or PleurX catheter. A clinic was developed to enable followup on a regular basis by a specialist nurse. Outpatient visits, regular telephone support and input from community nursing teams allowed management of this patient group. Audit of the clinic revealed a reduction in length of hospital stay (to 7.3 days) for patients with prolonged air leaks following surgery