Pleural Procedures Admission Avoidance Clinic
When : Wednesday 09:00-13:00
Where : Respiratory out-patients, Level 2, Queens Building, Bristol Royal Infirmary
Inclusion criteria: Any adult patient with pleural disease that needs investigating. This includes pleural
effusions, pneumothorax follow-up, pleural thickening.
NB: The clinic is set up to perform diagnostic pleural taps and therapeutic pleural aspirations.
Any patient requiring a procedure must be physically capable of sitting on edge of trolley
independently whilst procedure is performed
Exclusion criteria:
Patients who are systemically unwell
How to access service: Fax referral form to 0117 3422921
The clinic is every Wednesday morning. We will endeavour to see all patients the Wednesday after
they are referred with the deadline being Tuesday 13:00 unless discussed with the consultant in
charge. If the clinic is full priority will be given to those who need symptomatic relief to avoid
admission and patients referred in the 2 week wait category.

Please ensure patient contact telephone number is included. We will contact them by phone to give an
appointment time.

Please attach a copy of the patients recent medications.

If attending from AE, please ensure a copy of the AE notes are attached.
If referring patients for a procedure please ensure they are aware of
this and that they may be in the department for some time
Pleural Procedures Admission Avoidance Clinic Referral Form
1
Patient details (In Block Capitals):
Name:
M/F:
d.o.b:
NHS Number:
Hospital Number:
Address:
GP details:
Name:
Practice:
Address:
Postcode:
Postcode:
Telephone No:
Name of referrer:
Contact number/bleep of referrer:
Date and time of referral:
Referral from: GP / 2WW / ED / Medical Take / Signature of referrer:
Oncology / Other_____________________
Please answer the following questions to help us allocate appropriate time for procedures:
□Investigative Referral (Pleural disease to be investigated and followed up by Pleural Clinic) See Box 1
□Therapeutic Referral (Results and follow up to be organised by referring team) See Box 2
Pleural Effusion: Y/N
Is the patient taking:
Significant SOB: Y/N
2WW Referral: Y/N
Warfarin Y/N (Recent INR ___)
Clopidogrel Y/N
Box 1 - Reason for referral:
Box 2 – Procedures Required
Fluid required for analysis Y/N
□Protein, LDH
□MC+S
□Cytology
□AFB
Other (Please specify)_________________________________________________
Therapeutic Aspiration Required Y/N
If Yes does the patient:
Have known diagnosis Y/N If Y what is it_________________________
Had previous failed pleurodesis Y/N
Had previous complications from pleural procedures_________________________________
Have any reason why procedure may be difficult____________________________________
2