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

ABSTRACT

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.