Project Lead: Dr. Edgar Lau

Since December 1, 2018, a total of 9 bronchoscopies were performed in the Richmond Emergency Department on an urgent basis. 6 were performed for possible tuberculosis and 2 cases were confirmed microbiologically. Those 2 cases were discharged post-bronchoscopy on the same day and referred to the BC Centre for Disease Control on an outpatient basis. The other cases were performed within 24 hours of admission and smear results were available within 48 hours to allow discontinuation of airborne isolation procedures. One of these cases was discharged the day after admission.

Of the 2 confirmed cases, the initial diagnostic and treatment plans from the emergency physicians involved included admission to either medicine or hospitalist services. One case was referred after 1400 on a Friday afternoon. The MINIMUM delay to obtain an ambulatory care bronchoscopy in that instance would have been 4 days. The second case was referred after 1500 on a Tuesday and there would have been a potential delay of 7 days until the next ambulatory care slot the following week .  Obtaining diagnostic samples on an emergency room visit and awaiting the results in otherwise stable patients was appropriate in these instances, saving both admission days and airborne isolation time.

One other patient with potential TB (who later had an alternative diagnoses confirmed) was discharged one day post-bronchoscopy. The other 3 patients were admitted and had diagnostic material available within 24 hours of admission, which clarified discharge planning and isolation needs in a timely fashion.

There are other potential patients that would benefit from the approach of early bronchoscopy in the Emergency Department. These would include patients requiring airborne isolation for potentially communicable respiratory pathogens as well as immunocompromised patients with a broad range of potential pathogens.