Improving quality and safety in thoracostomy
management: A digital chest drainage system
intervention
Lyndon Rebello, Jennifer Lester, Darren Chan, Katie
McTaggart, Jolene Milkowski, Madison Chester, Lori
Pockiak, Claire Martin, Meagan Blair, Aaron Pengelly, Liz
McKay, L., Jaquelynne Demmy, David White, Greg Culp,
Dennis Kim, and Christopher Picard
Background: Trauma care across Vancouver Island is delivered
at two trauma centres, which serve a population of 864,000. As
part of program planning and delivery we routinely monitor
Patient Safety Learning System (PSLS) reports, survey staff, and
conduct case (MTPRC) reviews. Using these mechanisms, we
identified the need to standardize care practices, improve staff
training, and simplify the management of thoracostomy tubes.
Our intervention introduced a digital chest drainage system to
replace the gravity drainage system.
Methods: We used a mixed-methods approach to identify practice issues and design and analyze quality improvement (QI)
efforts. We analyzed open and directed staff surveys, text parsed
bulk PSLS reports, and manual selected MTPRC cases. Patient
Safety Learning System and MTPRC responses were coded thematically using conventional content analysis. Staff satisfaction
with the QI work was assessed using Wilcoxon signed-ranks testing. Ongoing longitudinal assessment of the QI intervention will
be used to describe the clinical impact of the QI intervention.
Results: Surveys identified that most nurses, 57.5% (n = 40),
wanted chest tube training. The least understood aspects of care
were assessing air leaks, tidalling, and excess negativity; and
changing the collection canisters. We screened PSLS reports
between 2022 and 2024 (n = 4300), limited them by catchment area (n = 1945), text-parsed them as chest-tube related
(n  =  116), then manually screened them to identify 11 trauma-related chest tube events. Coding of PSLS (n = 11) and
MTPRC cases (n = 14) identified two causal themes: i) management inconsistency (in physician ordering and clinical governance), and, ii)  device issues (chest tubes, securement, and
collection canisters and space). These cases resulted in delayed
care (including prolonged stay) in three cases, unnecessary tube
(re)placement (n = 12), and clinical deterioration (n = 3).
Our QI initiative implemented a digital drainage system. Digital
systems automatically modulate thoracic negativity, digitally display air-fluid leaks and tidalling, and provide audio-visual alarms
and prompts to address pump and collection canister issues. Canadian Journal of Emergency Nursing · Vol. 48, No. 3, Fall 2025 17 Orientation sessions trained 76.5% of staff. Postimplementation
surveys (n = 18) showed 61.1% or respondents had used the
digital system. Most rated the digital system as safer (z = 3.67,
r = 0.61, p < 0.01), easier (z = 3.66, r = 0.61, p < 0.01), superior
(z = 3.78, r = 0.63, p < 0.01), and preferable (z = 3.87, r = 0.64,
p  < 0.01) to gravity drainage. The response was not attributable to difference in the perceived level of training (z = 1.41,
p = 0.16). Ongoing analysis on the clinical effect of the system
will be available by the time of the conference.
Implications and lessons learned: We used small-scale surveys to assess staff, large-scale PSLS surveillance to identify
rare safety events, and a mixed-methods approach to identify
opportunities for QI. We used digital chest drainage system to
address the most cited challenges in chest tube care. As a result,
we have seen an increase in staff perceptions of patient safety
and ease of care. Ongoing analyses will determine if this initiative is correlated with changes in patient outcomes and safety
events.