Rapid Availability: Do Disposable Bronchoscopes Drive Increased Use?

Background: Bronchoscopy aids in viewing airway anatomy to determine treatment plans. Current infection prevention guidelines for bronchoscope reprocessing are rigid, time consuming, and create risk. Respiratory therapists (RTs) assist in bronchoscopy procedures from set up to equipment reprocessing. Cost often inhibits departments from purchasing unlimited reusable scopes which are fragile and limits availability. We aim to reduce risk in reprocessing, repair, purchase costs, and evaluate the convenience impact of disposable bronchoscopes (DB) in a 766-bed hospital facility (Level 1 Trauma Center, Academic Adult Care Facility). Methods: An IRB exempt retrospective review (7/1/2022 to 09/30/2023) assessed frequency and cost of bronchoscopy services for ICU patients (119 beds). Affected RTs and providers were educated on the use of DB. The new equipment and process was implemented in February of 2023 with appropriate education, EMR, and policy updates. The following data metrics were reviewed for the 7 months pre and post go live to determine impact: number of bronchoscopies completed, number of ventilator days, time per procedure, number of trained RTs, and cost per procedure. Results: After implementation of DB, RT time per procedure was reduced by 43 min. RT labor cost per procedure was reduced by $35.11, however supply cost per procedure was increased by $163.34 (excludes original capital purchase for reusable supplies). Additional capital costs for reusable bronchoscopes were estimated at $113.38 per procedure (based on 3,192 bronchoscopies over 7-year life span for 9 scopes and 3 carts). Ease of use of DB allowed for additional staff to be trained, increasing available trained RTs from 20% to 67.5% (Table 1). There was no difference in number of bronchoscopy procedures performed per 1,000 ventilator days pre- and post-implementation (27.01 to 28.18). The total additional cost for disposable equipment was $14.85 per procedure. Conclusions: Our facility prioritizes value efficiency, and while DB incurs added costs, reduced RT procedure time offsets labor expenses. The increase of trained RT caregivers for this procedure, increases availability, access, and provides opportunities for RT career growth. The absence of notable procedure increases suggests that enhancing access and availability may not significantly impact utilization. Further research must be done relative to infection prevention impact and within outpatient and pediatric care environments.Assessment of Utilization Pre- and Post-Implementation of Disposable Bronchoscopy Products Pre-Implementation(7/2022-1/2023)Post-Implementation(3/2023-9/2023)Reusable Procedures26718Disposable Procedures0246Total Procedures267264Ventilator Days9,5689,369Procedures per 1,000 Ventilator Days27.9128.18Table 1 details the number of procedures with reuseable and disposable bronchoscopy products in our adult facility pre- and post-implementation of disposable products.Cost Impact of Reusable vs. Disposable Bronchoscopes Reusable BronchoscopesDisposable BronchoscopesRT Time per Procedure78 min35 minNumber of RT Trained / Total RTs15 / 7450 / 74Average Wage of Trained RTs$45.11$40.33RT Labor Cost per Procedure$58.64$23.53Material Cost per Procedure$18.95$350.00Reprocessing Cost per Procedure$90.00$0.00Maintenance Service Contract per Procedure$77.71$0.00Total Cost per Procedure (excluding capital investment)$245.30$373.53Total Capital Investment$361,908.96$0.00Total Cost per Procedure (including capital investment)$358.68$373.53Table 2 reviews the cost impact of service delivery with each product line in our adult facility.