New Review Highlights Safety Concerns in Pleural Procedures Across the UK

10 March 2025

A new review has identified significant safety concerns in pleural procedures across the UK raising the need for better training, improved ultrasound use, and clearer protocols.

The research, conducted by Dr Andrew E Stanton and colleagues, reviewed patient safety incidents from the National Reporting and Learning System (NRLS) between April 2018 and March 2022. The report provides critical insight into the risks associated with these procedures.

Key Findings:

21 pleural-related safety incidents were identified from 256 reports, including two deaths.

The most common error was organ puncture, particularly the liver, raising serious concerns about procedural accuracy.

Documentation of Ultrasound (TUS) was often missing, or TUS may have been used inappropriately, despite being a key safety measure.

Many incidents occurred outside respiratory environments, both during and outside normal working hours.

The authors emphasise that improving patient safety requires a national focus to standardise best practice in pleural procedures. They underline that as stated in the 2023 BTS Pleural Guidelines, ultrasound assessment should be mandatory before any pleural intervention involving fluid. Better training and clearer protocols are also needed to ensure that ultrasound is used appropriately and consistently across all clinical settings. To further reduce the risk of harm associated with emergency procedures performed by less experienced clinicians, access to trained pleural proceduralists should be available at all times.

Raising awareness at a national level is essential to ensure that all professional groups that undertake pleural procedures recognise and address the issues highlighted in this study. The authors also express support for the upcoming National Confidential Enquiry into Patient Outcome and Death study. This review hopes to identify underlying factors contributing to procedural risks and to drive meaningful improvements. Local healthcare providers should conduct regular reviews of their pleural procedural practices to ensure compliance with safety standards and encourage greater collaboration among teams responsible for these interventions.

Dr Stanton commented,

“We still don’t fully understand why these episodes of harm are occurring, so we welcome an upcoming NCEPOD study to understand this in much more detail. Importantly though this study highlights the importance for teams in all clinical areas treating pleural effusions that ultrasound must be fully embedded in clinical protocols and used appropriately to provide safe intervention, in line with national published British Thoracic Society Guidance.”

Dr Stanton and colleagues stress that, while pleural procedures are essential for many respiratory patients, stronger adherence to safety protocols and improved training will be key to reducing patient harm. Despite improvements since the 2008 NPSA alert, findings indicate that more work needs to be done to ensure patient safety. National organisations and NHS trusts are urged to take proactive steps to improve safety and standardisation in pleural care.

For further information, read the full review.