The frequency and complexity of pleural disease is increasing. Patients with pleural disease have traditionally been managed as inpatients and cared for by a variety of teams, many of whom have had limited expertise in pleural pathology or its management. However, there have been major advances in our understanding of pleural disease in recent years. Patients have more options, and modern management algorithms can facilitate outpatient treatment. Safety reports in the last two decades have also highlighted the morbidity associated with pleural procedures, particularly in the setting of poor operator knowledge and experience. Consequently, there has been a growing realisation that early input from dedicated pleural services can foster ambulatory pathways, limit unnecessary procedures and improve patient safety. However, delivering subspecialist care within the resource constraints of modern healthcare is challenging. This chapter provides an overview of the requirements for good practice and outlines the advantages of the hub-and-spoke model in providing high-quality care while maintaining health equity.

Cite as: George V, Evison M. The specialist pleural service: when, why and who? In: Maskell NA, Laursen CB, Lee YCG, et al., eds. Pleural Disease (ERS Monograph). Sheffield, European Respiratory Society, 2020; pp. 282–294 [https://doi.org/10.1183/2312508X.10024519].