Affiliations: Institute of Child Health, University of Liverpool,
Royal Liverpool Children's Hospital, Liverpool, UK | Royal Liverpool Children's Hospital, Liverpool,
UK
Note: [] Correspondence: Dr. Fauzia Paize, Institute of Child Health,
University of Liverpool, Royal Liverpool Children's Hospital, Liverpool, L12
2AP, UK. Tel.: +44 151 2525693; Fax: +44 151 2525456; E-mail:
fauziapaize@MSN.com
Abstract: There are no reports of the use of an integrated care pathway (ICP)
to facilitate the management of pleural empyema in children. Our aim is to
assess pleural empyema management in our institute, to establish an ICP and to
review the impact of this on the patient journey. Data were collected about
management strategies, pain control and length of hospital stay from children
admitted in 2000 with a diagnosis of pleural empyema. An integrated care
pathway was developed to facilitate change in practice and provide greater
consistency in management. This incorporated the use of intrapleural urokinase
and guidelines on pain control. This was followed by data collection in 2004 to
review the impact of the integrated care pathway. The 2000 review revealed that
the majority of children (eight of 13) underwent a primary surgical
intervention. Urokinase was not used. The median length of stay was 11.5 days
(range 4–49 days). Implementation of the pathway led to a reduction in the
number of children who underwent surgery (one of 18) with no adverse impact on
clinical outcome. Median length of stay was 9 days (range 2–28 days). Children
had a smoother patient journey, with prompter investigation and intervention.
Children on the pathway had smaller chest drains inserted, received urokinase
and had a clearly recorded analgesia strategy. Pleural empyema in childhood
requires multi-disciplinary management. The implementation of an integrated
care pathway is a valuable tool for managing a condition that requires
multi-disciplinary input.
Keywords: Integrated care pathway, pleural empyema, intrapleural urokinase
