Patient Pathway

1. Patient identified as suitable for discharge home with a chest drain Ambulatory drain fitted CXR satisfactory Pain controlled Patient education Given contact details • Epidural removed • Pain controlled • Bowels opened • Mobilising • Support at home Drain needs to remain insitu Suction not required Home Advice from telephone helpline as required • Nurse led clinic: • Respiratory assessment • CXR • Drain assessment Drain removed Admission for further treatment Follow-up in consultant led clinic Drain not removed Introduction of a Nurse Led Clinic for Patients Discharged Home with a Chest DrainJenny Mitchell, Advanced Nurse Practitioner – Thoracic SurgeryCardiothoracic Surgery, John Radcliffe Hospital A group of patients undergoing thoracic surgical procedures were identified as fit for discharge home apart from continuing to require intercostal drainage. The Advanced Nurse practitioner for thoracic surgery has introduced a nurse led clinic to provide follow up for these patients until the drains are removed, facilitating early discharge. Patient Pathway Intercostal Drains Patient’s have either a Rocket Ambulatory Chest Drain bag or a Atrium Express Mini 500 canister fitted prior to discharge. These are both dry seal drains with a strap to allows the patient to wear the drain across their body. They can be inverted and are safe for use outside of hospital. Patient Education The purpose and function of the drain is discussed with the patient and their carers prior to discharge. They are given written information about the drain, how to care for it and who to contact if they have concerns. The GP and community nursing team are contacted to provide wound care and support to the patient and their carers. Conclusion This new service aims to enhance the pathway of this group of thoracic surgery patients by facilitating early discharge and improving patient support and communication with the aim of improving patient satisfaction References: Malik M and Black E (2009) Fast-track video-assisted bullectomy and pleurectomy for pneumothorax: initial experience and description of technique. European Journal of Cardiothoracic Surgery. 36 906-9. Reiger K, Wroblewski H, Brookes J, Hammond Z and Kesler K (2007) Postoperative Outpatient Chest Tube Management: Initial Experience With a New Portable System. Annals of Thoracic Surgery. 84 630-2.