P273 A novel ambulatory pleural effusion pathway in a tertiary referral hospital in ireland reduced pleural effusion admissions by 31% over 9 months

Background Traditionally, pleural effusion procedures in Ireland are performed in the inpatient setting. Recent evidence from other jurisdictions shows that ambulatory pathways for pleural effusion procedures avoids admission, lowers healthcare costs and improves patient experiences. Previous audit data from our centre showed that 96% of pleural effusion procedures were performed in the inpatient setting. We established a pilot Ambulatory Pleural Effusion Pathway, in partnership with community nursing colleagues, for assessment and management of pleural effusions in the outpatient setting, offering diagnostic and therapeutic assessment of pleural patients. Here, we sought to assess the impact of our pilot pathway on inpatient admissions.Methods Our pathway was launched in September 2024. We performed a retrospective review of all patients cared for through the Ambulatory Pleural Effusion Pathway over the first nine months of this pilot. Data was collected regarding patient demographics, referral source, days from referral to assessment, underlying diagnosis, and procedures performed. The numbers of procedures performed at the Ambulatory Pleural Effusion Procedure list was compared to previous audit-based estimates of the number of pleural effusion procedures performed in our centre in order estimate the number of avoided admissions.Results Over 9 months, the pathway provided care for 43 individual patients, including 102 in-person reviews at the ambulatory pleural list and 235 telephone contacts with our Pleural CNS. 43 patients underwent 55 procedures, including 30 thoracocenteses, 3 pleural biopsies, 5 IPC insertions, 27 IPC reviews, 2 IPC insertions, and 1 chest drain insertion. 57% of patients had malignant pleural disease, and 47% were older than 75 years. 55% were referred by the Oncology Service. Previous audit data indicated 236 inpatient pleural effusion procedures performed over one year (=177 over nine months), and that those potentially suitable for ambulatory management (i.e. with no other medical issues requiring admission) had average LOS of 14.9 days. Based on this, our pilot pathway reduced admissions involving pleural effusion procedures by 31% (i.e. 55/177), saving 894 bed days over 9 months.Abstract P273 Figure 1Conclusion A pilot Ambulatory Pleural Effusion Pathway can substantially reduce admissions to an Irish hospital for pleural effusion procedures and save bed days.