An analysis of wait times for bronchoscopy Referrals during the covid-19 pandemic in a Tertiary care centre

The COVID-19 pandemic has reshaped the structure of healthcare provision. Bronchoscopy is an essential diagnostic tool for investigating patients with malignant and non-malignant respiratory diseases, but is an aerosol generating procedure. In our centre, essential endoscopic services continued during the COVID-19 pandemic, with several measures to ensure patient and staff safety. Aim We aimed to identify whether there was a significant delay in access to flexible bronchoscopy (FB) and endobronchial ultrasound (EBUS) for urgent cases during the COVID-19 pandemic. Method We reviewed the numbers of procedures and wait time from referral to endoscopy for three periods: Three months prior to the COVID-19 pandemic (December 2019-February 2020), three months during the 'peak' COVID-19 pandemic (March-May 2020) and during the 'recovery' period (June-mid August 2020). Data was analysed with ANOVA and chi-square tests for statistical significance. Results 532 patients underwent FB or EBUS from December 2019-August 2020 (table 1). There was a significant reduction in total and FB procedures during the peak pandemic which has persisted during the recovery period. When comparing pre-COVID months to COVID peak, there was no significant difference in wait for total endoscopy procedures (p=0.8442) or EBUS (p=0.0624), respectively. There was a significant increase in wait for FB (p£0.001). There was an improved wait time for total endoscopy procedures and EBUS after June 2020 (p£0.001 for both). Discussion The COVID-19 pandemic resulted in a significant reduction in the total numbers of FB and EBUS procedures performed but did not result in a significant increase in waiting time for procedure. The prioritization of cancer services over alternative indications for bronchoscopies is the most likely explanation for this difference in numbers performed. The patient-related consequences of these changed diagnostic pathways is unclear. The introduction of mandatory COVID-19 swabbing on the 29th April did not lead to significant delays. Our review demonstrates that it is possible to maintain rapid-access bronchoscopy services in the height of the COVID-19 pandemic.

Maintenance of bronchoscopy services during the covid-19 pandemic: Experience from a Tertiary care centre

Bronchoscopy is an aerosol-generating procedure (AGP) and the COVID-19 pandemic has necessitated changes in provision of our service. This retrospective analysis reviews our institutional response to maintaining safe and efficient bronchoscopy services throughout the COVID-19 pandemic. Aim To analyse changes in numbers of and indications for flexible bronchoscopy (FB) and endobronchial ultrasound (EBUS) between December 2019-August 2020, and the mitigating measures introduced by our centre to keep the service operating. Method Data was pulled from our procedure database for the three months pre-COVID-19 (December 2019-February 2020), the COVID peak (March to May 2020) and the 'recovery' phase (June-mid August 2020). Patient records were analysed for the indication for procedure and diagnosis. Cancelled procedures and research bronchoscopies were excluded. Results 433 procedures were undertaken during the study period. Figure 1 shows the number of endoscopic procedures by indication and procedure type. There was an overall decrease in procedures during the pandemic, with predominantly EBUS cancer procedures being undertaken. The number of cancer cases performed across all three periods was comparable. Pre-procedure COVID swabs became mandatory in our institution from 29th April 2020. Of 167 cases, two were postponed (1 positive test and 1 febrile patient on procedure day). No patients were cancelled during pre-procedural telephone COVID-19 screening. Discussion Bronchoscopy procedures declined during the COVID-19 pandemic. However, our service maintained 4 lists per week during the peak with reinstatement of six lists during the COVID-endemic period. Bronchoscopy training was maintained with all lists having an assigned trainee. AGPrelated air exchange protocols limited the number of procedures per list and elective procedures were postponed early in the pandemic. Our centre had a proactive approach to running the service, introducing mandatory pre-procedure COVID swabbing early together with telephone screening pre-BTS guidance. Staff safety was prioritised via universal use of powered airpurifying respiratory (PAPR) use which eliminated the need for mask-fit testing and seeking FFP3 mask availability. It is feasible to maintain a safe and efficient bronchoscopy service in the midst of a pandemic with the implementation of appropriate pathways and provision of adequate personal protective equipment.

'Pleural triage' facilitates effective Management of a pleural service in the covid-19 era

Aims The COVID-19 pandemic has created new challenges for management of pleural diseases. Pleural patients can be highly vulnerable to infection and often have conditions for which treatment cannot be safely delayed. We reviewed our pleural service to implement changes that allowed maintenance of a service whilst maximising patient and staff safety. Method Establishment of a Pleural Triage MDT meeting 48 hrs prior to pleural clinic to review all referrals and stream patients to i) telephone consultation only, ii) remote CXR (24 hrs pre-clinic) plus telephone consultation iii) face-to-face (F2F) review or iv) direct to a procedure. We reviewed case numbers post lockdown for March-August 2020 and compared to 2019. Results During the COVID pandemic outpatient pleural management was implemented where possible, including adaptation of our ambulatory pneumothorax pathway to comply with COVID-19 recommendations. March-August 2019 there were 293 F2F pleural consultations. March-August 2020 there were 408 consultations [103 telephone only, 168 remote CXR + telephone consult (11 declined) and 123 F2F (3 declined)]. The 14 declines had telephone consults only. Previously all these patients would have been F2F. COVID-19 symptom screening occurred if attending for CXR/F2F. F2F consults were held in designated outpatient areas with access to CXR and procedure rooms, with timings to maintain social distancing. Where required, definitive pleural intervention was undertaken on the same visit. Direct-to-procedure pathways for thoracoscopy or IPC were implemented with COVID-testing 48 hrs prior. Patients with malignant effusions were counselled on management options and uptake of day-case IPC increased [March-August 2020 vs 2019 IPC = 44 vs 35] compared to elective admission for drain and talc pleurodesis. During the April 2020 COVID peak there were 12 admissions for chest drain vs 50 in April 2019. The pleural/cancer themed ward was designated a COVID-negative area for inpatients. Conclusion In the ever-changing situation of a global pandemic it is possible to successfully implement changes to maintain and enhance the safety and efficiency of pleural services, with selected changes likely to remain post-pandemic. Further evaluation of these changes over time could help to shape the future of pleural medicine.

P29 Maintenance of bronchoscopy services during the COVID-19 pandemic: Experience from a tertiary care centre

P29 Figure 1DiscussionBronchoscopy procedures declined during the COVID-19 pandemic. However, our service maintained 4 lists per week during the peak with reinstatement of six lists during the COVID-endemic period. Bronchoscopy training was maintained with all lists having an assigned trainee. AGP-related air exchange protocols limited the number of procedures per list and elective procedures were postponed early in the pandemic.Our centre had a proactive approach to running the service, introducing mandatory pre-procedure COVID swabbing early together with telephone screening pre-BTS guidance. Staff safety was prioritised via universal use of powered air-purifying respiratory (PAPR) use which eliminated the need for mask-fit testing and seeking FFP3 mask availability.It is feasible to maintain a safe and efficient bronchoscopy service in the midst of a pandemic with the implementation of appropriate pathways and provision of adequate personal protective equipment.

P30 An analysis of wait times for bronchoscopy referrals during the COVID-19 pandemic in a tertiary care centre

P30 Table 1December 2019-February 2020March – May 2020June – mid August 2020Number of procedures (n) Total257128147 FB1364758 EBUS1218189Mean wait (days) Total8.178.237.40FB6.767.946.83EBUS9.099.428.17DiscussionThe COVID-19 pandemic resulted in a significant reduction in the total numbers of FB and EBUS procedures performed but did not result in a significant increase in waiting time for procedure. The prioritization of cancer services over alternative indications for bronchoscopies is the most likely explanation for this difference in numbers performed. The patient-related consequences of these changed diagnostic pathways is unclear. The introduction of mandatory COVID-19 swabbing on the 29th April did not lead to significant delays.Our review demonstrates that it is possible to maintain rapid-access bronchoscopy services in the height of the COVID-19 pandemic.

P26 ‘Pleural Triage’ facilitates effective management of a pleural service in the COVID-19 era

P26 Figure 1ConclusionIn the ever-changing situation of a global pandemic it is possible to successfully implement changes to maintain and enhance the safety and efficiency of pleural services, with selected changes likely to remain post-pandemic. Further evaluation of these changes over time could help to shape the future of pleural medicine.ReferenceGuidance on pleural services during the COVID-19 pandemic;https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/