Improving Bronchoscopy Safety and Diagnostic Yield in Lung Transplant Recipients

PurposeBronchoscopy is invaluable in the diagnosis of airway complications, infection, and rejection lung transplant recipients, a fundamental skill pulmonology fellowship training. We aimed to improve bronchoscopy safety diagnostic yield our teaching institution by targeting two quality metrics: 1) higher patient radiation exposure fellow-assisted compared attending-only procedures 2) variability documentation exam findings.MethodsUsing an A3 lean approach, we assessed current conditions retrospective review bronchoscopies over four months. Then, established target ≤ 2 times that standardized per ISHLT grading. Next, conducted gap analysis identify root causes implemented countermeasures twelve months.ResultsIn conditions, mean was 2.6 ± 0.3 than attending-only. targeted fluoroscopy duration, lack knowledge, variable feedback with these countermeasures: tracking exposure, self-assessment competency, access education video, post-procedure attending feedback. As result, achieved 11/12 months (92%). In included ischemia, malacia stenosis < 20% bronchoscopies. knowledge creating templated report multiple choice options document grading placed representative graphics suite. dehiscence, malacia, were documented > 80% bronchoscopies.ConclusionWe successfully reduced difference fellow assisted implementing using approach. Bronchoscopy findings. Using