Evaluating the impact of nurse practitioner involvement in a pleural procedures clinic
Pleural disease incidence is increasing and there has been a move towards outpatient management. Pleural clinics have been developed for patients to be assessed and have pleural procedures for diagnostic and symptomatic purposes.
The study aimed to assess the impact of nurse practitioner (NP) involvement in a pleural procedures clinic on clinic capacity, and staff and patient experience.
A mixed-methods service evaluation was completed in a medium-sized general hospital. The number of patients seen in clinic over a 6-month period at the beginning of NP involvement was compared with the number of patients seen 1 year later. Semi-structured interviews of key staff stakeholders were conducted.
Clinic capacity increased from 4.57 to 5.86 patients per list. NP involvement increased access, improved patient care, reduced work burden for other staff and improved educational opportunities.
The impact of NP involvement in the pleural clinic was seen as positive and increased clinic capacity. The same model of practice could be considered elsewhere.
Incidence of pleural disease is increasing (Bhatnagar and Maskell, 2013), affecting 3000 people per million each year (Du Rand and Maskell, 2010). Patients can present with pleural effusions associated with pleural disease or other pathologies, such as alternative malignancy, infection or left ventricular failure (Bintcliffe et al, 2016). Breathlessness associated with pleural effusions can be disabling and, therefore, access to therapeutic and potential diagnostic pleural aspiration to provide immediate relief of symptoms is essential (Bintcliffe et al, 2016).
Traditional inpatient management of pleural effusions often requires protracted and costly admissions. New systems, such as outpatient pleural procedure clinics (PPC), have been developed to avoid this (Antunes et al, 2003, Hooper et al, 2015, Botana Rial et al, 2010). Outpatient pleural services aim to provide rapid access, reduce emergency hospital admissions and provide effective and safe care that is preferred by patients (Sura et al, 2012; Bhatnagar and Maskell, 2013; Devani et al, 2016).
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