{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T17:10:13Z","timestamp":1756660213027,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:00:00Z","timestamp":1695686400000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2023,9,7]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Malignant pleural effusions (MPE) can cause severe dyspnoea leading to greater than 125\u2009000 hospitalisations per year and cost greater than US$5\u2009billion per year in the USA. Timely insertion of tunnelled pleural catheters (TPCs) is associated with fewer inpatient days and emergency department visits. We conducted a quality improvement study to reduce hospital admissions of patients with MPE.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Key stakeholders were surveyed, including thoracic and breast oncology teams, general pulmonary and interventional pulmonology (IP) to help identify the underlying causes and solutions. Our preintervention group consisted of 51 patients who underwent TPC placement by our IP service. In our first intervention, we reviewed referrals for MPE with the scheduling team and triaged them based on urgency. In the second intervention, we added a follow-up phone call 1\u2009week after the initial thoracentesis performed by IP to assess for the recurrence of symptoms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Demographic and clinical characteristics were summarised across the three groups. We evaluated the rate ratio (RR) of admissions in the intervention groups with the multivariable Poisson regression and adjusted for race, gender and cancer. Compared with the preintervention group, intervention I showed trends towards a 41% lower hospital admission rate (RR 0.59 (0.33\u20131.07), p=0.11). Compared with the preintervention group, intervention II showed trends towards a 40% lower hospital admission rate (RR 0.6 (0.36\u20130.99), p=0.07). The results did not reach statistical significance. Exploratory comparisons in readmission rates between interventions I and II showed no difference (RR 0.89 (0.43\u20131.79), p=0.75).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Both interventions showed trends toward fewer hospital readmissions although they were not statistically significant. Larger-size prospective studies would be needed to demonstrate the continued effectiveness of these interventions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjoq-2022-002197","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T13:00:42Z","timestamp":1695733242000},"page":"e002197","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Reducing hospital admissions in patients with malignant pleural effusion: a quality improvement study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0270-3036","authenticated-orcid":false,"given":"Rebecca R","family":"Cloyes","sequence":"first","affiliation":[{"name":"Pulmonary, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Enambir","family":"Josan","sequence":"additional","affiliation":[{"name":"Pulmonary, The University of Tennessee Medical Center, Knoxville, Tennessee, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Pastis","sequence":"additional","affiliation":[{"name":"Pulmonary, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianing","family":"Ma","sequence":"additional","affiliation":[{"name":"Biostatistics, The Ohio State University, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilly","family":"Palettas","sequence":"additional","affiliation":[{"name":"Biostatistics, The Ohio State University, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Peng","sequence":"additional","affiliation":[{"name":"Biostatistics, The Ohio State University Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Vasko-Wood","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea","family":"Mohrman","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Ghattas","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolyn","family":"Presley","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Revelo","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasleen","family":"Pannu","sequence":"additional","affiliation":[{"name":"The Ohio State University Wexner Medical Center, Columbus, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,26]]},"reference":[{"key":"2025083109493074000_12.3.e002197.1","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.chest.2016.11.010","article-title":"US hospitalizations for malignant pleural effusions","volume":"151","author":"Taghizadeh","year":"2017","journal-title":"Chest"},{"key":"2025083109493074000_12.3.e002197.2","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1016\/j.chest.2017.08.026","article-title":"Quality gaps and comparative effectiveness of management strategies for recurrent malignant pleural effusions","volume":"153","author":"Ost","year":"2018","journal-title":"Chest"},{"key":"2025083109493074000_12.3.e002197.3","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(197404)33:4<916::AID-CNCR2820330405>3.0.CO;2-U"},{"key":"2025083109493074000_12.3.e002197.4","doi-asserted-by":"crossref","first-page":"e547","DOI":"10.1200\/JOP.18.00201","article-title":"Patient- and hospital-level factors associated with readmission for malignant pleural effusion","volume":"14","author":"Yang","year":"2018","journal-title":"J Oncol Pract"},{"key":"2025083109493074000_12.3.e002197.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.09.007"},{"key":"2025083109493074000_12.3.e002197.6","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s13670-018-0246-0","article-title":"Malignant pleural effusions\u2014personalised management","volume":"7","author":"Ahmed","year":"2018","journal-title":"Curr Geri Rep"},{"key":"2025083109493074000_12.3.e002197.7","doi-asserted-by":"crossref","unstructured":"Twose C , Ferris R , Wilson A , et al . 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