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1 From the Divisions of Pulmonary and Critical Care Medicine and General Internal Medicine, Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Gregory Diette, MD, MHS, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Blalock 910, 600 N. Wolfe St., Baltimore, MD 21287; e-mail: gdiette{at}welchlink.welch.jhu.edu
Study objective: To apply the principles of quality improvement to measure the frequency and severity of symptoms that result from fiberoptic bronchoscopy (FOB), and to identify opportunities to improve FOB practice by identifying factors about patients and the process of care that predict these symptoms.
Design: Concurrent longitudinal cohort study.
Patients: Four hundred ninety-three adult patients who underwent FOB.
Measurements and results: Patients completed questionnaires just prior to FOB and again at 48 h postprocedure. Patients were asked to rate the severity of nose pain, throat pain, swallowing pain, and chest pain, and the frequency of coughing, hemoptysis, phlegm, shortness of breath, wheezing, difficulty swallowing, fever, and chills. Symptom severity was reported on a four-point ordinal scale. Findings: Significant worsening was found for nose pain, throat pain, swallowing pain, and hemoptysis. Shorter patients experienced more throat pain and hemoptysis, and longer procedure time predicted nose pain and hemoptysis.
Conclusions: Bronchoscopy causes nose pain, throat pain, swallowing pain, and hemoptysis to a larger extent than previously has been recognized. There are opportunities to improve the patient experience with bronchoscopy by using smaller bronchoscopes in shorter patients, shortening the procedure length, and reanesthetizing the nares in longer procedures.
Key Words: fiberoptic bronchoscopy • patient self-report • quality improvement • symptoms
Submitted on March 6, 1998
Accepted on June 9, 1998
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