Clinical pathway for malignant pleural effusion (MPE): design, implementation process and early clinical outcomes.

I. Matus*^a (Dr), V. Krishna Matta^b (Dr), J. Pellenbarg^a (Mrs)

^a Thoracic Surgery and Interventional Pulmonology Service, Helen F. Graham Cancer Center and Research Institute, Christiana Care, Newark, De, UNITED STATES ; ^b Department of Medicine, Christiana Care, Newark, De, UNITED STATES

* ismael.matus@christianacare.org

Background:

Malignant Pleural Effusion (MPE) impacts the quality of life (QOL) of this patient population with limited life expectancy while carrying a significant healthcare-burden and inpatient mortality rate. The initial diagnostic evaluation and therapeutic management of pleural effusions are commonly shared by various specialty services both in the outpatient, emergency room (ER) and inpatient settings. Non-standardized approaches may lead to fragmented care translating into multiple therapeutic and diagnostic procedures, or their delay. This current approach to the management of MPE may negatively impact patients’ QOL, increase time spent in healthcare facilities and costs.

Method:

Clinical pathway created based on survey-identified areas for improvement in the management of malignant pleural effusion at our single 1299 bed institution.

Retrospective comparison as part of an interim report of outcomes between first (N=85) and second (N=87) consecutive cohorts after pathway implementation.

Outcomes include number of ER visits and hospitalizations, average number of pleural interventions per patient, number of specialty services performing interventions and number of emergent interventions avoided.

Results:

ER visits and hospitalizations due to symptomatic MPEs ( 43 vs. 25, p=0.03; 37 vs. 21, p=0.02 respectively), average number of pleural procedures per patient ( 2.19 vs. 2.21, p=0.47) and service lines performing procedures (1.14 vs. 1.06, p= 0.18) and emergent interventions avoided ( 29 vs. 43, p= 0.18 ), in the first vs. second consecutive cohorts, respectively.

Conclusion:

Implementation of MPE clinical pathway’s centralized care, as experience was gained, offered a reduction of time spent in healthcare facilities and avoidance of emergent interventions, thereby potentially optimizing patients’ quality of life.

In addition to these interim findings and upon completion of our ongoing comparison with our pre-pathway control cohort, we hypothesize the pathway’s improved access to care will lower cost of care by additionally demonstrating reductions in total number of interventions upon delivering sooner definitive pleural palliative interventions.

Disclosure of funding source(s): none