Differential implementation of special society pleural guidelines according to craft-group: impetus toward cross-specialty guidelines?

We examined the effects of a programme to improve adherence to British Thoracic Society pleural procedure guidelines at our institution. Following a baseline audit, we performed an intervention to enhance adherence to these guidelines. We then performed a postintervention audit. At baseline, there were different levels of guideline adherence depending on the specialty of the clinician inserting chest tubes. Interventions to improve adherence were hampered by limited access to non-respiratory teams. Thus, improvements in response to intervention were also specialty specific. Overall, procedures performed by respiratory medicine had higher adherence rates compared with those performed by non-respiratory teams. We concluded that guidelines promoted at a local level by one specialty have limited traction on members of another specialty. For pleural procedures, which cross specialty boundaries, we propose that future guidelines be developed jointly by all relevant specialties. This could facilitate unified guideline implementation at the clinical coalface.