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Background: Pleural effusion is a common cause of hospitalisation and a poor prognostic marker that is associated with morbidity and mortality. The evaluation and management of pleural effusion may be performed more effectively by a specialised pleural disease service (SPDS). Aims: To evaluate the impact of a SPDS established in 2017 at a 400‐bed metropolitan hospital in Victoria, Australia. Methods: A retrospective observational study was undertaken comparing outcomes of individuals with pleural effusions. People with pleural effusion were identified using administrative data. Two 12‐month time periods were compared, 2016 (Period 1, before SPDS) and 2018 (Period 2, after SPDS). Results: Period 1 had n = 76 and Period 2 had n = 96 individuals with pleural effusion receiving intervention. Age (69.8 ± 17.6 vs 71.8 ± 15.8), gender and Charlson Comorbidity Index (4.9 ± 2.8 vs 5.4 ± 3.0) were similar across both periods. Utilisation of point‐of‐care ultrasound for pleural procedures increased from Period 1 to 2, 57.3–85.7% (P < 0.001). There was a reduction in median days from admission to intervention (3.8–2.1 days, P = 0.048) and pleural‐related re‐intervention rate (32% vs 19%, P = 0.032). Pleural fluid testing was more consistent with recommendations (16.8% vs 43.2%, P < 0.001). Overall, there was no difference in the median length of stay (7.9 vs 6.4 days, P = 0.23), pleural‐related readmissions (11% vs 16%, P = 0.69) or mortality (17.1% vs 15.6%, P = 0.79). Procedural complications were similar between the two periods. Conclusions: The introduction of a SPDS was associated with increased point‐of‐care ultrasound utilisation for pleural procedures, shorter delays to intervention and improved standardisation of tests on pleural fluid. [ABSTRACT FROM AUTHOR]