Patient- and Hospital-Level Factors Associated With Readmission for Malignant Pleural Effusion

Yang, Theresa S; Hsia, David; Chang, Dong

doi:10.1200/jop.18.00201

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…MPE is a common diagnosis on readmissions and many procedures for MPE are performed in the hospital because of this. 4 However, the preintervention group consisted of more inpatient referrals also and had more patients who went directly to hospice once the TPC was inserted after the initial referral order. The intervention I and II groups consisted of more patients in which IP did a thoracentesis first.…”

Section: Discussionmentioning

confidence: 99%

“…3 The average hospital length of stay for MPE is 5 days. 4 One in four patients with MPE is WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Malignant pleural effusions (MPE) lead to many hospital admissions due to disabling dyspnoea and the necessary procedures that ensue. This quality improvement project was performed to determine if we could identify strategies to decrease hospital admissions in this population.…”

Section: Available Knowledgementioning

confidence: 99%

“… 3 The average hospital length of stay for MPE is 5 days. 4 One in four patients with MPE is readmitted to the hospital within 30 days of discharge if thoracentesis alone was used as the primary modality for drainage. 5 Furthermore, lack of symptom palliation and recurrent hospitalisation is associated with lower quality of life (QOL).…”

Section: Introductionmentioning

confidence: 99%

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Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study

Cloyes,

Josan,

Pastis

et al. 2023

BMJ Open Qual

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BackgroundMalignant pleural effusions (MPE) can cause severe dyspnoea leading to greater than 125 000 hospitalisations per year and cost greater than US$5 billion per year in the USA. Timely insertion of tunnelled pleural catheters (TPCs) is associated with fewer inpatient days and emergency department visits. We conducted a quality improvement study to reduce hospital admissions of patients with MPE.MethodsKey stakeholders were surveyed, including thoracic and breast oncology teams, general pulmonary and interventional pulmonology (IP) to help identify the underlying causes and solutions. Our preintervention group consisted of 51 patients who underwent TPC placement by our IP service. In our first intervention, we reviewed referrals for MPE with the scheduling team and triaged them based on urgency. In the second intervention, we added a follow-up phone call 1 week after the initial thoracentesis performed by IP to assess for the recurrence of symptoms.ResultsDemographic and clinical characteristics were summarised across the three groups. We evaluated the rate ratio (RR) of admissions in the intervention groups with the multivariable Poisson regression and adjusted for race, gender and cancer. Compared with the preintervention group, intervention I showed trends towards a 41% lower hospital admission rate (RR 0.59 (0.33–1.07), p=0.11). Compared with the preintervention group, intervention II showed trends towards a 40% lower hospital admission rate (RR 0.6 (0.36–0.99), p=0.07). The results did not reach statistical significance. Exploratory comparisons in readmission rates between interventions I and II showed no difference (RR 0.89 (0.43–1.79), p=0.75).ConclusionsBoth interventions showed trends toward fewer hospital readmissions although they were not statistically significant. Larger-size prospective studies would be needed to demonstrate the continued effectiveness of these interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Available Knowledgementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study

Cloyes,

Josan,

Pastis

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

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“…8 Long-term management of recurring pleural effusions can be challenging, especially in the face of malignant pleural effusions where hospital readmissions are common. 9,10 These patients require symptom management, timely follow-up, and access to specialists. However, continuity of care and access to care are often disrupted during transitions of care across clinical settings.…”

Section: Introductionmentioning

confidence: 99%

The Role of Ultrasound-Guided Therapeutic Thoracentesis in an Outpatient Transitional Care Program: A Case Series

Segaline

Wang

Bethancourt

et al. 2019

Am J Hosp Palliat Care

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Background: Symptomatic pleural effusions create discomfort and are a frequent cause of hospitalization. Ultrasound-guided thoracentesis is a key palliative intervention to assist in the management of this vulnerable population. Our institution has created a multidisciplinary transitional care program to address the needs of those discharged from the hospital with chronic complex conditions, including symptomatic pleural effusions. Methods: This case series was performed in a transitional care clinic between May 8, 2017, and December 11, 2018. Eight unique patients with symptomatic pleural effusions were referred to our clinic posthospital discharge and treated with ultrasound-guided thoracentesis. A retrospective review was performed to assess procedure details, complications, and follow-up emergency department visits or hospital readmissions. Additionally, cost comparison data were obtained from the hospital financial system. Results: Of the 8 unique patients, 15 thoracenteses were performed over the 19-month period in the transitional care clinic. The median age of the cohort was 56 years old (range: 39-92 years). All patients reported an immediate relief of symptoms (dyspnea and/ or pain) and no procedural complications. The total cost of performing an ultrasound-guided thoracentesis in the transitional care clinic was 61.8% that of performing the procedure in the hospital (US$537.61 vs US$869.65). Conclusion: All 8 patients experienced an immediate relief in pleural effusion-related symptoms following thoracentesis. Our experience helps reveal the safety, efficacy, and cost-efficiency of ultrasound-guided thoracentesis in providing symptom management for patients with pleural effusions in a transitional care clinic.

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Early Readmission to Hospital in Patients With Cancer With Malignant Pleural Effusions

Mitchell

Dhaliwal

Mulpuru

et al. 2020

Chest

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Patient- and Hospital-Level Factors Associated With Readmission for Malignant Pleural Effusion

Cited by 3 publications

References 24 publications

Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study

Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study

The Role of Ultrasound-Guided Therapeutic Thoracentesis in an Outpatient Transitional Care Program: A Case Series

Early Readmission to Hospital in Patients With Cancer With Malignant Pleural Effusions

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