Inadequate Procedural Reporting Impairs Reporting of Quality Indicators in Bronchoscopy With Endobronchial Ultrasound

Endobronchial ultrasound (EBUS) is an essential tool in the diagnosis and accurate mediastinal staging of lung cancer. Quality indicators are concise, evidence-based measures that reflect key aspects of high-quality care and can be used to assess the standard of interventional procedures. The World Association of Bronchology and Interventional Pulmonology has recently published a set of such indicators for EBUS procedures. This study examines the feasibility of auditing these quality indicators using semistructured procedural reports.

In 2021, a retrospective audit of all EBUS procedures at a single tertiary lung cancer referral centre in Melbourne, Australia, was performed. During the 12-month period, the audit measured 12 proposed quality indicators for patient records. We tracked the time and resources required to measure quality indicators using our current systems.

Three hundred seventy-five EBUS procedures (244 linear and 131 radial) were reviewed. Due to the semistructured nature of procedural reports, the information required to report the quality indicators was frequently not found in the report and required significant extra time to capture. Of the 12 quality indicators, four could be reported using the procedure and pathology reports alone. The procedural indication was inadequately documented in 48% of patients, which impaired the ability to report quality indicators examining staging completeness and diagnostic outcomes. Two quality indicators could not be reported due to a lack of routinely collected data.

Our institution's current semistructured procedural reporting practices compromise the ability to accurately report quality measures. Significant resources are required to establish quality measures for many quality indicators. Synoptic reporting would assist in reporting performance measures and auditing quality and safety in EBUS and should be examined in future studies.