Performance monitoring of EBUS for the staging and diagnosis of lung cancer: auditing the Greater Manchester EBUS service against new national standards

Abstract

IntroductionEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a pivotal test in lung cancer staging and diagnosis, mandating robust audit and performance monitoring of EBUS services. We present the first regional cancer alliance EBUS performance audit against the new National EBUS specification.MethodsAcross the five EBUS centres in the Greater Manchester Cancer Alliance, data are recorded at the point of procedure, when pathological results are available and at 6 months postprocedure to review any further pathological sampling (eg, at surgical resection) and the outcome of clinical–radiological follow-up. Outcomes across all five centres were compared with national standards for all lung cancer EBUS procedures from 01 January 2017 to 31 December 2018.Results1899 lung cancer staging or diagnostic EBUS procedures were performed across the five centres during the study period; 1309 staging EBUS procedures and 590 diagnostic EBUS procedures. Major complications were seen in six cases (<1%). All five trusts demonstrated performance above that set national standards in key metrics for both staging and diagnostic EBUS, however the provision of adequate tissue for predictive marker testing was below national standards at one trust. Across Greater Manchester, 72% and 64% of patients had their EBUS procedure performed within 7 days of referral in 2017 and 2018, respectively. Only one out of five trusts met the national targets of >85% of procedures performed within 7 days of referral.ConclusionThe National EBUS service specification is an important framework to drive the quality of EBUS services across the UK. Our data provide assurance of appropriate performance and safety while also highlighting specific areas for attention that can be addressed with the support of the cancer alliance.

Proposed quality indicators and recommended standard reporting items in performance of EBUS bronchoscopy: An official World Association for Bronchology and Interventional Pulmonology Expert Panel consensus statement

“…44 Prospective studies of centres performing EBUS for a mix of diagnostic/staging indications (i.e., patients with cN1-3, M0/1) suggest prevalence of pN2/3 disease may range from 29% to 61%. 121 As noted in this study, reduced diagnostic accuracy may in fact reflect patient selection, emphasizing the importance of reporting diagnostic sensitivity of EBUS-TBNA in NSCLC according to prevalence of pN2/3 disease in the cohort examined, particularly if concerns regarding performance exist.…”

Regional single-queue scheduling platform for specialist diagnostics in the lung cancer pathway: accelerating cancer recovery from the COVID-19 pandemic

“…Each EBUS provider, however, has differing capacity and resilience with the number of operators, for example, ranging from two to seven across the EBUS services. 7 This left services vulnerable to the impact of staff absence or sickness. The mechanism of referral was an email from referring hospital to EBUS provider.…”

“…Greater Manchester (GM) is a region in the North West of England with a population of over 3 million people and a significantly higher age-standardised mortality rate for lung cancer compared with the national average 5. EBUS services in GM have a long-standing history of collaborative working, predominantly with the purpose of quality assurance and performance monitoring 6 7. This work has, however, highlighted delayed and variable access to EBUS across the region with compliance to the national EBUS service specification8 quality standard of referral to procedure time of ≤7 calendar days ranging from 37% to 87% across the GM EBUS services 7.…”

“…EBUS services in GM have a long-standing history of collaborative working, predominantly with the purpose of quality assurance and performance monitoring 6 7. This work has, however, highlighted delayed and variable access to EBUS across the region with compliance to the national EBUS service specification8 quality standard of referral to procedure time of ≤7 calendar days ranging from 37% to 87% across the GM EBUS services 7. The management of capacity and demand for EBUS across the region could, therefore, be improved to ensure equitable and more rapid access to this specialist diagnostic test.…”

“…Prior to this pilot project, EBUS referral pathways in GM were relatively rigid with each of the 10 acute care hospital sites having one defined referral pathway to a single EBUS provider (from a total of five EBUS providers). Each EBUS provider, however, has differing capacity and resilience with the number of operators, for example, ranging from two to seven across the EBUS services 7. This left services vulnerable to the impact of staff absence or sickness.…”