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Moderate Sedation and Airway Preparation Practices in Bronchoscopy: Variation in Practices, Education and Impact of 2011 ACCP Guidelines
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A5024 - Moderate Sedation and Airway Preparation Practices in Bronchoscopy: Variation in Practices, Education and Impact of 2011 ACCP Guidelines
Author Block: D. Roto, M. Malnoske, C. Manganaris, M. Nead, S. Khurana; University of Rochester Medical Center, Rochester, NY, United States.
Background: Bronchoscopy is a common procedure performed by pulmonologists and a core skill taught to all fellows. In order to perform this procedure effectively, bronchoscopists should be skilled in providing safe and adequate moderate sedation (MS) and airway preparation (AP). Our previous data from 2009, demonstrated a lack of consistent MS/AP practices among United States Pulmonary/Critical Care Medicine (PCCM) fellowship programs. In 2011, the American College of Chest Physicians (ACCP) issued a consensus statement of standardized guidelines for MS and AP. The impact of this statement on PCCM fellowship programs is unknown. We present the findings of our 2017 survey of MS/AP practices amongst PCCM fellowships.
Methods: A 28-question survey was emailed to 147 PCCM fellowship coordinators. The survey included questions on the presence of a standardized curriculum for MS/AP, knowledge of the ACCP consensus statement, most common methods of MS/AP, and complications frequencies as a result of inadequate MS/AP. Part of the survey was filled out by the program director (PD) or interventional bronchoscopist (IB), while another portion was completed by senior pulmonary fellows. The data was then compared to the 2009 results.
Results: A total of 104 responses were obtained. Responders included 23 PD/IB (15% response rate) and 81 senior fellows (55% response rate). Of pulmonary faculty, 56% answered ‘yes’ to their program having a standardized curriculum for AP and 71% for MS. 65% of fellows indicated that their program either did not have a standardized curriculum or they were unaware of one. This is an increase from 2009, when 50% of fellows indicated not having a curriculum. Although all PD/IB were aware of the ACCP consensus statement, only 14% of fellows reported the same. 95% of fellows indicated having to alter a procedure secondary to inadequate MS/AP and 45% reported witnessing a complication secondary to inadequate MS/AP; this represents an increase from our prior data, previously reported as 83% and 30%, respectively.
Conclusion: Our data suggest that despite availability of 2011 ACCP MS/AP consensus statement, there continues to be significant variability in MS/AP practices and education across academic PCCM programs. These findings underscore the gap that often exists between guideline publication and implementation. Our study’s limitations include small sample size.
Author Block: D. Roto, M. Malnoske, C. Manganaris, M. Nead, S. Khurana; University of Rochester Medical Center, Rochester, NY, United States.
Background: Bronchoscopy is a common procedure performed by pulmonologists and a core skill taught to all fellows. In order to perform this procedure effectively, bronchoscopists should be skilled in providing safe and adequate moderate sedation (MS) and airway preparation (AP). Our previous data from 2009, demonstrated a lack of consistent MS/AP practices among United States Pulmonary/Critical Care Medicine (PCCM) fellowship programs. In 2011, the American College of Chest Physicians (ACCP) issued a consensus statement of standardized guidelines for MS and AP. The impact of this statement on PCCM fellowship programs is unknown. We present the findings of our 2017 survey of MS/AP practices amongst PCCM fellowships.
Methods: A 28-question survey was emailed to 147 PCCM fellowship coordinators. The survey included questions on the presence of a standardized curriculum for MS/AP, knowledge of the ACCP consensus statement, most common methods of MS/AP, and complications frequencies as a result of inadequate MS/AP. Part of the survey was filled out by the program director (PD) or interventional bronchoscopist (IB), while another portion was completed by senior pulmonary fellows. The data was then compared to the 2009 results.
Results: A total of 104 responses were obtained. Responders included 23 PD/IB (15% response rate) and 81 senior fellows (55% response rate). Of pulmonary faculty, 56% answered ‘yes’ to their program having a standardized curriculum for AP and 71% for MS. 65% of fellows indicated that their program either did not have a standardized curriculum or they were unaware of one. This is an increase from 2009, when 50% of fellows indicated not having a curriculum. Although all PD/IB were aware of the ACCP consensus statement, only 14% of fellows reported the same. 95% of fellows indicated having to alter a procedure secondary to inadequate MS/AP and 45% reported witnessing a complication secondary to inadequate MS/AP; this represents an increase from our prior data, previously reported as 83% and 30%, respectively.
Conclusion: Our data suggest that despite availability of 2011 ACCP MS/AP consensus statement, there continues to be significant variability in MS/AP practices and education across academic PCCM programs. These findings underscore the gap that often exists between guideline publication and implementation. Our study’s limitations include small sample size.
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