When should I consider referring a patient with empyema to secondary care for further management?

Consider referring a patient with empyema to secondary care for further management if:

• There is clinical suspicion or confirmation of empyema, as it often requires specialist interventions such as drainage or surgery not typically managed in primary care.
• The patient shows signs of severe infection or complications, including systemic symptoms or failure to improve with initial antibiotic therapy.
• There is evidence of respiratory compromise or significant pleural fluid accumulation on imaging that may require thoracic intervention.
• Patients with comorbidities or risk factors that complicate management, such as immunosuppression or poor response to treatment, should be referred promptly.

In summary, any patient with empyema who is not improving, has severe disease, or requires invasive management should be referred to secondary care for further assessment and treatment.