Efficiency of performing pulmonary procedures in a shared endoscopy unit: procedure time, turnaround time, delays, and procedure waiting time

Procedural times with robotic-assisted bronchoscopy: a high volume single-center study

BACKGROUND

Incidental and screen-detected pulmonary nodules are common. The increasing capabilities of advanced diagnostic bronchoscopy will increase bronchoscopists' procedural volume necessitating optimization of procedural scheduling and workflow.

OBJECTIVES

The objectives of this study were to determine total time in the procedure room, total bronchoscopy procedure time, and robotic-assisted bronchoscopy procedure time longitudinally and per specific procedure performed.

DESIGN

A single-center observational study of all consecutive patients undergoing shape-sensing robotic-assisted bronchoscopy (RAB) biopsy procedures for the evaluation of pulmonary lesions with variable probability for malignancy.

METHODS

Chart review to collect patient demographics, lesion characteristics, and procedural specifics. Descriptive and comparative statistics are reported.

RESULTS

Actual bronchoscopy procedure time may decrease with increased institutional experience over time, however, there is limited ability to reduce non-bronchoscopy related time within the procedure room. The use of cone beam computed tomography (CBCT), rapid on-site evaluation (ROSE), and performance of staging endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in a single procedure are each associated with additional time requirements.

CONCLUSION

Institutional procedural block times should adapt to the nature of advanced diagnostic bronchoscopy procedures to allow for the accommodation of new modalities such as RAB combined with other technologies including radial endobronchial ultrasound, CBCT, ROSE, and staging linear EBUS. Identifying institutional median procedural times may assist in scheduling and ideal block time utilization.

Evaluating and Improving the Efficiency of Patient Flow in the Bronchoscopy Suite in a Tertiary Care Center: A QI Project!

PURPOSE

The bronchoscopy suite is where pulmonologists perform the majority of their procedures like bronchoscopy, endobronchial ultrasound, and navigational bronchoscopy among others. Faculty and fellows in our division have reported multiple delays in the procedure start time in our bronchoscopy.

OBJECTIVES

Objectives of the study were (1) to identify the areas of delays in procedure start time, (2) to identify potential high-yield areas of interventions to reduce delays, (3) to assess the impact of interventions on efficacy of bronchoscopy suit.

METHODS

We have conducted a quality improvement project aiming at identifying areas of delays and implemented an intervention aiming at minimizing those delays. We retrospectively collected the data about the patient flow from arrival to hospital to discharge between June and August 2016. We used fishbone technique to identify the potential reasons for delay in procedures and to identify low-effort high-yield areas. Our intervention was raising awareness and education among the personnel and designing the process to reduce time delays and improve efficacy. We collected the data about the patient flow prospectively after the invention was implemented.

RESULTS

The study showed that 76.4% of our preintervention procedures had a late start time. The postintervention results revealed a statistically significant reduction in the procedure late start times by 24.4% (P = .02). Signing the procedure H and P was also identified as a major area of delay, which has improved postintervention (65.5 % vs 33.3%, P = 0.017).

CONCLUSION

The faculty and fellows' perceptions were translated into objective data, which serves as a first step in our division to improve the patient flow process in the bronchoscopy suite. Areas of delays were identified and our intervention resulted in significant improvement, but more work needs to be done to achieve a more efficient patient flow in the bronchoscopy suite while maintaining a safe patient care.