Synoptic Reporting Improves Quality of Endobronchial Ultrasound (EBUS): An Australian Multicentre Study

Introduction: Accurate mediastinal staging with endobronchial ultrasound (EBUS) is essential in determining prognosis and management of patients with non-small cell lung carcinoma (NSCLC). Procedural documentation is often variable and incomplete due to reliance on free-text reporting. Synoptic reporting, which is a structured, standardised approach, improves documentation quality in other specialties, but has not been evaluated in EBUS. This study aimed to evaluate the impact of synoptic reporting on quality metrics in systematic staging EBUS. Methods: This multicentre ambispective study was conducted across five Australian tertiary hospitals. Synoptic reporting was implemented for EBUS procedures where systematic staging is recommended. Outcomes from three months of pre-intervention data were compared with three months post-intervention. The primary outcome was completeness of systematic mediastinal staging. Secondary outcomes included number of lymph nodes sampled per procedure, number of radiologically normal nodes sampled, detection of positron emission tomography (PET)-occult lymph node metastases, and report completeness. Results: Ninety-six procedures were included pre-intervention, and 77 post-intervention. Complete mediastinal staging increased from 17/96 (17.7%) to 67/77 (87%) (OR 3.2; p < 0.001). The mean number of lymph nodes sampled per procedure increased from 1.75 to 2.45 (p < 0.001), and sampling of radiologically normal nodes increased from 37/96 (38.5%) to 55/77 (71.4%) (OR 3.95; p < 0.001). Detection of PET-occult nodal metastases increased from 3/96 (3.1%) to 9/77 (11.7%) (OR 4.07; p = 0.036). Report completeness improved across most mandated domains. Conclusions: Synoptic procedural improves the quality and performance of systematic staging EBUS and represents a scalable quality improvement intervention.