Abstract Rationale Bronchoscopy is an essential medical intensive care unit (MICU) procedure that lacks cost transparency, especially when distinguishing between reusable and single-use scopes. The cost efficiency of reusable vs sing-use bronchoscopy in the literature is debated based on numerous variables, including equipment costs and maintenance, infection risk, clinical urgency, and institution-based practices. We aimed to perform a multi-modal cost analysis and utilization review of single use vs reusable bronchoscopy in the MICU to inform value-based practice. Methods This mixed-methods quality improvement initiative was conducted in the Cleveland Clinic MICU. Over a 12-month period (Jan-Dec 2024), we extracted data on procedure volume, maintenance and reprocessing costs, and contractual expenses (Olympus, Steris) for reusable scopes and compared this to purchase costs for single-use. Additionally, we integrated the cost of human factors such as time-based compensation for parties involved. Scope utilization was obtained from Epic and manual respiratory therapy (RT) inventory. We performed Gemba walk observations in the MICU to better understand real-world workflows, scope handling, and potential loss points. We also distributed targeted surveys to RTs and fellows to assess awareness of documentation practices and scope selection Rationale: We calculated cost per use using standard depreciation modeling. Stakeholder meetings (physicians, RTs, finance, and clinical operations) informed identification of billing gaps, contract discrepancies, and cultural practice variation. Results In 2024, the MICU performed 310 bronchoscopies, of which 230 (74%) were reusable and 80 (26%) were single-use. Cost analysis including available cleaning (∼50. 50/use), maintenance, staffing costs (∼28. 05/use), purchase costs, and depreciation demonstrated that reusable scope costs totaled 44, 722, equating to 184/use. Single-use scope costs totaled 20, 800, equating to 260/use. Forecast modeling for optimal cost savings showed that no greater than 22% single-use utilization was preferred, driven largely by purchase price and depreciation of existing reusable equipment. Billing workflows failed to distinguish scope type and offered no specific upcharge or modifier for single-use scopes. Investigation revealed lack of documentation standardization, inventory accountability, and absence of process clarity on how scope type influences charge generation. Current contracts lack clear delineation of per-scope cleaning cost or volume tiers. Conclusion In the absence of deliberate scope tracking and billing standardization, MICU bronchoscopy practice incurs opaque and potentially avoidable costs. Our early findings challenge the assumption that reusable scopes are intrinsically cheaper, especially when hidden costs and under-billing of disposables are considered. Ongoing interventions include Epic template redesign, unit-specific inventory audits, alternative billing strategies, and vendor appraisals. This abstract is funded by: None
Howell et al. (Fri,) studied this question.