Retrospective Audit of Flexible Bronchoscopy Practice at Kenyatta National Hospital - a 5 Year Audit

Abstract

Background: Since the discovery of flexible fiber optic bronchoscopy (FB) by S. Ikeda in 1964. It has become an important diagnostic and therapeutic tool for management of chest disease. There are numerous indications for bronchoscopy including peripheral pulmonary nodule, hemoptysis, chronic cough, pleural effusion, recent or unresolved pneumonia, pulmonary tuberculosis, and lung collapse. Routine clinical audit of flexible bronchoscopy practice is guideline recommendation of British thoracic society, the aim of these audits is to review level compliance with the guideline/standards. Compliance with the guidelines enhance standardization of practice, outcomes and patient safety. The audits review the structure, processes and outcomes of practice to ensure efficacy and patient safety. There is paucity of data on the practice, safety and efficacy of flexible bronchoscopy in Kenya thus this will be a novel study. Objective: To determine the flexible bronchoscopy practice at Kenyatta National Hospital. Design: Retrospective medical audit. Setting and Duration: The study will be conducted at Kenyatta National Hospital Respiratory Disease Unit and is anticipated to take 2 months. Population: The study population will be medical files of patients aged 13 years and above who underwent flexible bronchoscopy in at the RDU of Kenyatta national hospital between January 2016 and December 2020. Methods: A retrospective clinical audit of 250 flexible bronchoscopies done over the last 5 years will be conducted. The audit will review the processes and outcomes of the practices using as structured checklist to collect data needed to meet the study objectives. The process audits will review practices in pre-procedure patient preparation, anaesthetic technique, patient monitoring, indications for the procedures, sampling techniques and pattern of findings. The outcome review will evaluate the histopathologic or microbiologic yield of the specimen collected and the immediate complications. Analysis: The data will be collected using a structured study proforma with unique study serial number to avoid duplication. Data forms will be kept in a secure cabinet accessible only to the PI. All data from the study proforma will be coded, entered and managed in a Microsoft access. Data will then be entered, cleaned and analyzed using Statistical Package for Social Sciences (SPSS version 21.0). Continuous data will be presented as means and medians while categorical data will be analyzed and presented as proportions.