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  • Measure Summary
  • NQMC:010946
  • Dec 2014

Diagnostic flexible bronchoscopy: proportion of bronchoscopies done with the appropriate number, skill mix and competence of staff.

British Thoracic Society (BTS). Quality standards for diagnostic flexible bronchoscopy in adults. London (UK): British Thoracic Society (BTS); 2014 Dec. 37 p.  (British Thoracic Society Reports; no. 5). [28 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Structure

Secondary Measure Domain

Clinical Quality Measure: Process

Description

This measure is used to assess the proportion of bronchoscopies done with the appropriate number, skill mix and competence of staff.

Rationale

Staff numbers and skill mix in endoscopy are influenced by health care provider demands and changes, variation in patient complexity, and changes in sedation practices.

The number of patients, patient acuity, and physical layout of the unit, available technology, and staff education, experience and competency must be considered in determining appropriate staffing levels.

A high quality, patient-centred endoscopy service depends on staff who are properly trained, adequately supported, have balanced skill mix and are recognised and rewarded for a job done well.

The British Thoracic Society (BTS) guideline for diagnostic flexible bronchoscopy in adults (Du Rand et al., 2013) and the BTS guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults (Du Rand et al., 2011) are the main references for the quality standards.

Evidence for Rationale

British Thoracic Society (BTS). Quality standards for diagnostic flexible bronchoscopy in adults. London (UK): British Thoracic Society (BTS); 2014 Dec. 37 p.  (British Thoracic Society Reports; no. 5). [28 references]

Du Rand IA, Barber PV, Goldring J, Lewis RA, Mandal S, Munavvar M, Rintoul RC, Shah PL, Singh S, Slade MG, Woolley A, British Thoracic Society Interventional Bronchoscopy Guideline Group. British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults. Thorax. 2011 Nov;66(Suppl 3):iii1-21. [131 references] PubMed External Web Site Policy

Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, Mandal S, Martin J, Mills J, Navani N, Rahman NM, Wrightson JM, Munavvar M, British Thoracic Society Bronchoscopy Guideline Group. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax. 2013 Aug;68(Suppl 1):i1-44. [303 references] PubMed External Web Site Policy

Primary Health Components

Flexible bronchoscopy; staffing level; skill mix; competence of staff

Denominator Description

Number of procedures carried out

Numerator Description

Number of procedures carried out with the appropriate staffing level, skill mix and competency (see the related "Numerator Inclusions/Exclusions" field)

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Ambulatory Procedure/Imaging Center

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Clinical Administrators/Managers

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Does not apply to this measure

Target Population Gender

Does not apply to this measure

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Diagnostic Evaluation

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Number of procedures carried out

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Number of procedures carried out with the appropriate staffing level, skill mix and competency

Note: Minimum staffing levels during bronchoscopy procedures include:

  • A suitably trained and competent bronchoscopist to consent the patient, co-ordinate the safety checklist, administer sedation and perform the required procedure.
  • A minimum of two suitably trained and competent endoscopy assistants, of whom at least one is a qualified nurse, to be present at endoscopy.
    • One assistant is dedicated to assisting the bronchoscopist during the procedure.
    • One assistant is dedicated to patient care, to monitor the patient's safety, comfort and wellbeing and to communicate significant changes to the bronchoscopist.
  • An additional endoscopy assistant to assist the team during more advanced bronchoscopic procedures, such as endobronchial ultrasound (EBUS) or cryoBx/diathermy, etc.
  • A suitably trained and competent health care professional available to perform pre-procedure care, assessment and intravenous (IV) cannulation prior to bronchoscopy.
  • A suitably trained and competent health care professional available to monitor and assess the patient during the recovery period.
  • A suitably trained and competent person available to adequately clean and decontaminate bronchoscopy equipment.

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Quality statement 2d.

Measure Collection Name

Quality Standards for Diagnostic Flexible Bronchoscopy in Adults

Submitter

British Thoracic Society - Medical Specialty Society

Developer

British Thoracic Society - Medical Specialty Society

Funding Source(s)

British Thoracic Society

Composition of the Group that Developed the Measure

A Quality Standards Working Group was convened in September 2013, with the following membership:

  • Dr Ingrid Du Rand, Co-Chair, consultant respiratory physician, Hereford
  • Dr M Munavvar, Co-Chair, consultant respiratory physician, Preston
  • Dr Jonathan Bennett, consultant respiratory physician, Leicester
  • Dr John Blaikley, senior lecturer and honorary consultant respiratory physician, Manchester
  • Dr Richard Booton, consultant respiratory physician, Manchester
  • Dr Nazia Chaudhuri, consultant respiratory physician, Manchester
  • Dr James Finnerty, consultant respiratory physician, Chester
  • Dr Vandana Gupta, specialist registrar in respiratory medicine, Manchester
  • Dr Saifudin Khalid, consultant respiratory physician, Blackburn
  • Dr Swapna Mandal, specialist registrar in respiratory medicine, London
  • Ms Julie Martin, respiratory nurse consultant, Manchester
  • Mrs Anne McCloy, lay representative
  • Ms Janet Mills, respiratory nurse, Preston
  • Dr Neal Navani, consultant respiratory physician, London
  • Dr Najib Rahman, consultant respiratory physician, Oxford
  • Dr John Wrightson, consultant respiratory physician, Oxford

Financial Disclosures/Other Potential Conflicts of Interest

Members of the Quality Standards Group submitted Declaration of Interest forms in line with the British Thoracic Society (BTS) policy and copies of forms are available online via the BTS Web site External Web Site Policy or on request from the BTS Head Office.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2014 Dec

Measure Maintenance

The Quality Standards document will be reviewed in 2018 or following the publication of a revised guideline, whichever is the sooner.

Date of Next Anticipated Revision

2018

Measure Status

This is the current release of the measure.

Source(s)

British Thoracic Society (BTS). Quality standards for diagnostic flexible bronchoscopy in adults. London (UK): British Thoracic Society (BTS); 2014 Dec. 37 p.  (British Thoracic Society Reports; no. 5). [28 references]

Measure Availability

Source available from the British Thoracic Society (BTS) Web site External Web Site Policy.

For more information, contact BTS at 17 Doughty St, London, WC1N 2PL; Tel: ++ 44 (0) 20 7831 8778; Fax: ++ 44 (0) 20 7831 8766; E-mail: bts@brit-thoracic.org.uk; Web site: www.brit-thoracic.org.uk External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on November 15, 2016. The information was verified by the measure developer on January 4, 2017.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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