SHM Converge Scientific Abstract ePoster Gallery-Optimizing Pleural Effusion Management Through Implementation of a Complex Effusion Management Team

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This quality improvement project aimed to reduce delays in diagnosis and shorten hospital length of stay (LOS) for patients with parapneumonic pleural effusions at the University of Colorado Hospital. Historically, LOS was highly variable and averaged more than 15 days. To address fragmented care across services, the team created a multidisciplinary Complex Effusion Management Team (CEMT) that combines Hospital Medicine Procedure Service (MPS) and Pulmonary expertise with standardized workflows for pleural effusion evaluation and treatment.<br /><br />The CEMT was launched in August 2023 to formalize communication and create a consistent workflow for new effusions. In April 2024, the team increased visibility through presentations and email promotion. In September 2024, a clinical pathway was added to direct providers to consult the CEMT and to allow ordering of labs and consults directly from the pathway.<br /><br />Data were collected using a Pleural Effusion Dashboard, including patients with MPS consults, pathway use, or intrapleural lytic enzyme therapy (IPET); surgical patients were excluded. Statistical process control showed that average LOS decreased from 15 days to 10 days, with narrowing of both upper and lower control limits, suggesting improved consistency in care.<br /><br />The authors conclude that a multidisciplinary effusion management team, supported by standardized workflows and close collaboration, can reduce hospital LOS for patients with new pleural effusions. Future work will assess effects on chest tube placement, progression to surgical thoracotomy, and return on investment.

Asset Subtitle

Christopher J. King

Meta Tag

Author List Anunta Virapongse, Christopher J. King, Eric Grimm, Henry R. Kramer

Category Innovations

Concept Complex Effusion Management Team

Concept Parapneumonic Pleural Effusion

Concept Intrapleural Lytic Enzyme Therapy

Concept Hospital Length of Stay

Concept Pleural Effusion Care

Distinguished Non-Finalist

Presenter Organization University of Colorado, Division of Hospital Medicine

Presenting Author Christopher J. King

Track Quality Improvement

Keywords

parapneumonic pleural effusion

length of stay

quality improvement

multidisciplinary team

clinical pathway

hospital medicine

pulmonary expertise

standardized workflow

diagnosis delay

intrapleural lytic enzyme therapy

Complex Effusion Management Team

Parapneumonic Pleural Effusion

Intrapleural Lytic Enzyme Therapy

Hospital Length of Stay

Pleural Effusion Care