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

ABSTRACT

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.