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Providing safe and effective pleural medicine services in the UK: an aspirational statement from UK pleural physicians
  1. Matthew Evison1,
  2. Kevin G Blyth2,3,
  3. Rahul Bhatnagar4,5,
  4. John Corcoran6,
  5. Tarek Saba7,
  6. Tracy Duncan8,
  7. Rob Hallifax9,
  8. Liju Ahmed10,11,
  9. Alex West10,
  10. Justin Charles Thane Pepperell12,
  11. Mark Roberts13,
  12. Pasupathy Sivasothy14,
  13. Ioannis Psallidas9,
  14. Amelia O Clive4,5,
  15. Jennifer Latham15,
  16. Andrew E Stanton16,
  17. Nick Maskell4,5 and
  18. Najib Rahman9,17
  1. 1 Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
  2. 2 Pleural Disease Unit, Queen Elizabeth Hospital, Glasgow, UK
  3. 3 Institute of Infection, Immunity of Inflammation, University of Glasgow, Glasgow, UK
  4. 4 Academic Respiratory Unit, University of Bristol, Bristol, UK
  5. 5 North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
  6. 6 Interventional Pulmonology Service, Plymouth Hospitals NHS Trust, Plymouth, UK
  7. 7 Respiratory Medicine, Blackpool Victoria Hospital, Blackpool, UK
  8. 8 Pleural Service, North Manchester General Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
  9. 9 Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Trust, Churchill Hospital, Oxford, UK
  10. 10 Respiratory Medicine, Guys and St. Thomas NHS Foundation Trust, London, UK
  11. 11 Respiratory Medicine, Kings College School of Medicine, London, UK
  12. 12 Respiratory Medicine, Taunton and Somerset NHSF Trust, Taunton, UK
  13. 13 Respiratory Medicine, Sherwood Forest Hospitals NHS Foundation Trust, Nottingham, UK
  14. 14 Addenbrooke’s Hospital, Cambridge, UK
  15. 15 Respiratory Medicine, Raigmore Hospital, Inverness, UK
  16. 16 Respiratory Medicine, The Great Western Hospital, Swindon, UK
  17. 17 Oxford NIHR Biomedical Research Centre, Oxford, UK
  1. Correspondence to Dr Matthew Evison; matthew.evison{at}


Physicians face considerable challenges in ensuring safe and effective care for patients admitted to hospital with pleural disease. While subspecialty development has driven up standards of care, this has been tempered by the resulting loss of procedural experience in general medical teams tasked with managing acute pleural disease. This review aims to define a framework though which a minimum standard of care might be implemented. This review has been written by pleural clinicians from across the UK representing all types of secondary care hospital. Its content has been formed on the basis of literature review, national guidelines, National Health Service England policy and consensus opinion following a round table discussion. Recommendations have been provided in the broad themes of procedural training, out-of-hours management and pleural service specification. Procedural competences have been defined into descriptive categories: emergency, basic, intermediate and advanced. Provision of emergency level operators at all times in all trusts is the cornerstone of out-of-hours recommendations, alongside readily available escalation pathways. A proposal for minimum standards to ensure the safe delivery of pleural medicine have been described with the aim of driving local conversations and providing a framework for service development, review and risk assessment.

  • Pleural Disease

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  • Contributors The concept of this manuscript and clinical need for the piece of work was identified by ME. All authors contributed to the content of this manuscript through project meetings and teleconference. All authors have been involved in the writing and editing of the manuscript. ME has led the writing group with senior authorship provided by NM & NR. ME, NM and NR are responsible for the overall content as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement There are no additional data available.

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