Safe and effective pleural services: Does the UK’s Northern Deanery measure up?

Abstract

Background: In our region most pleural procedures are undertaken by or with the guidance of experienced respiratory physicians during normal working hours. A recent article1 assessing pleural services suggested guidelines for safe out of hours (OOH) provision. We aim to ascertain our current compliance with these aspirational guidelines. Method: Online questionnaire to medical registrars in the Northern region in January 2019. Data collected: grade, subspecialty, previous OOH procedures, logbook, procedural competency, thoracic ultrasound (TUS) competency, confidence rating. The data was reviewed by thematic analysis. Results: N=75, Respiratory trainees (RTs) 19 (30%). Compliance with all 13 questions was 100%. 60 (80%) had undertaken a procedure OOH. 56 (75%) had attended a basic skills course. 11 (15%) worked in trusts with a OOH pleural protocol. Only 29 (39%) had logbook evidence of at least 5 pleural procedures. 51 (68%) felt confident undertaking a pleural procedure OOH with the site marked prior. 26 (35%) have received formal TUS training, 19 of which are RTs, 49 (88%) of all non-RTs had not. 54 (72%) self-rated ‘not competent’ at TUS, 96% of non-RTs. 51 (68%) felt obtaining a log book for 10 pleural procedures would be difficult or unachievable. All non-RTs stated they require further training in pleural procedures to be “emergency level providers”. Conclusion: The majority of general medical trainees don’t feel competent providing an OOH pleural service. TUS competency, is the biggest challenge. Outsourcing radiology OOH means on site support is often not available. The provision of pleural services and perhaps training requires reviewing with this in mind. 1Evison M et al. BMJ Open 2018;5:e000307