Policy for the insertion of chest drains by trainees
The insertion of a pleural drain is a key area of competency that needs to be obtained prior to the attainment of the FACEM. In order to facilitate learning of the procedure whilst maximizing patient safety it is important that consultant supervision is in place for ALL insertions. The level of consultant supervision is dependent on the experience of the trainee.
Level 0: No prior experience with the procedure.
- Consultant input: Demonstrates and explains the procedure
Level 1: Has observed the procedure being performed
- Consultant input: Performs the procedure with trainee assistance
Level 2: Has performed the procedure under direct supervision
- Consultant input: Observes the procedure
Level 3: Has performed the procedure with indirect supervision
- Consultant input: Has been informed the procedure is taking place and is available to advise if necessary
Level 4: Can perform the procedure unsupervised (Consultants only)
To progress through competency levels each insertion needs to be assessed, documented and feedback provided. This should be done via the DOPS form (Direct Observation of Procedural Skills) for each trainee. Non-emergency medicine trainees will also have their competency assessed with the same assessment tool. Components of competency assessment include;
- Preparation for the procedure
- Technical aspects of the procedure with a particular emphasis on safe insertion technique
3) Post procedure management
No trainee should progress through the competency levels without fulfilling ALL competency components of the assessment. Additionally the progression from level 2 to level 3 requires the completion of an approved simulation course. Trainees at level 3 are still required to inform the duty emergency consultant of the procedure. Level 4 may only be obtained post fellowship.