Abstract
Background
Intercostal catheter (ICC) insertion is the standard pleural decompression and drainage
technique for blunt and penetrating traumatic injury. Potentially high complication
rates are associated with the procedure, with the literature quoting over 20% in some
cases (1–4). Empyema in particular is a serious complication. Risk adverse industries
such as the airline industry and military services regularly employ checklists to
standardise performance and decrease human errors. The use of checklists in medical
practice is exemplified by introduction of the WHO Surgical Safety checklist.
Methods
The Alfred Hospital in Melbourne, Australia is an Adult Level 1 Trauma Centre. In
August 2009 The Alfred Trauma Service introduced an evidence-based checklist system
for the insertion of ICCs, combined with standardised formal training for resident
medical staff, in an attempt to minimise the incidence of ICC related empyema.
Results
Between January 2003 and July 2009 the incidence of empyema was 1.44% (29 in 2009
insertions). This decreased to 0.57% between August 2009 and December 2011 (6 in 1060
insertions) when the measures described above were introduced [p = 0.038 Fisher's exact test, 2-tailed].
Conclusion
Quality control checklists – such as the ICC checklist described – are a sensible
and functional means to standardise practice, to decrease procedural error and to
reduce complication rates during trauma resuscitation.
Keywords
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Article info
Publication history
Published online: March 14, 2014
Accepted:
March 1,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
