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Research ArticleOriginal Research

Development of Quality Assurance and Quality Control Guidelines for Respiratory Oscillometry in Clinic Studies

Joyce KY Wu, Emily DeHaas, Richard Nadj, Aloysius Brandon Cheung, Ronald J Dandurand, Zoltán Hantos, Clodagh M Ryan and Chung-Wai Chow
Respiratory Care November 2020, 65 (11) 1687-1693; DOI: https://doi.org/10.4187/respcare.07412
Joyce KY Wu
Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Toronto General Pulmonary Function Laboratory, University Health Network, Toronto, Ontario, Canada.
Toronto Lung Transplant Programme, Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada.
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  • For correspondence: [email protected]
Emily DeHaas
Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Richard Nadj
Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Aloysius Brandon Cheung
Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Ronald J Dandurand
CIUSSS de L’Ouest-de-L’Île de-Montreal, Montreal Chest Institute, Meakins-Christie Labs, Oscillometry Unit and Centre for Innovative Medicine, McGill University Health Centre and Research Institute, Montreal, Quebec, Canada.
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Zoltán Hantos
Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary and with the Department of Technical Informatics and Engineering, University of Szeged, Szeged, Hungary.
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Clodagh M Ryan
Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Toronto General Pulmonary Function Laboratory, University Health Network, Toronto, Ontario, Canada.
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Chung-Wai Chow
Division of Respirology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Toronto General Pulmonary Function Laboratory, University Health Network, Toronto, Ontario, Canada.
Toronto Lung Transplant Programme, Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada.
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Abstract

BACKGROUND: The guidelines to conduct and interpret conventional pulmonary function (PFT) tests are frequently reviewed and updated. However, the quality assurance and quality control (QA/QC) guidelines for respiratory oscillometry testing remain limited. QA/QC guidelines are essential for oscillometry to be used as a diagnostic pulmonary function test (PFT) in a clinical setting.

METHODS: We developed a QA/QC protocol shortly after oscillometry was introduced in our laboratory as part of a clinical study. The first clinical study began after the research personnel completed 3 h of combined didactic and hands-on training and establishment of a standard operating protocol (SOP) for oscillometry testing. All oscillometry tests were conducted using the initial SOP protocol from October 17, 2017, to April 6, 2018. At this time, the first QA/QC audit took place, followed by revisions to the SOP, the addition of a QA/QC checklist, and the development of a 12-h training program. A second audit of oscillometry tests was conducted from April 9, 2018, to June 30, 2019. Both audits were completed by a registered cardiopulmonary technologist from the Toronto General Pulmonary Function Lab.

RESULTS: The first audit evaluated 197 paired oscillometry-PFT tests and found 10 tests (5.08%) to be invalid, with a coefficient of variation > 15%. The second audit examined 1,930 paired oscillometry-PFT tests; only 3 tests (0.16%) were unacceptable, with a coefficient of variation > 15%. Improvement in QA/QC was significantly better compared to the first audit (P < .001).

CONCLUSIONS: Although oscillometry requires minimal subject cooperation, application of the principles that govern the conduct and application of a PFT are important for ensuring that oscillometry testing is performed according to acceptability and reproducibility. Specifically, the inclusion of a SOP, a proper training program, a QA/QC checklist, and regular audits with feedback are vital to ensure that oscillometry is conducted accurately and precisely.

  • oscillometry
  • spirometry
  • plethysmography
  • quality improvement
  • practice guidelines
  • biological calibrations

Footnotes

  • Correspondence: Joyce KY Wu RCPT(P), University Health Network, 585 University Ave, 10N1015, Toronto, ON, Canada M5G 2N2. E-mail: joyce.wu{at}uhn.ca
  • This work was supported by a Pettit Block Term Grant, the Division of Respirology at the University of Toronto, the Princess Margaret Foundation, the Friends for Life Fund, and the Ontario Thoracic Society Grant in Aid. Dr Hantos is supported by Hungarian Scientific Research Fund Grant K128701. The authors have disclosed no conflicts of interest.

  • Supplementary material related to this paper is available at http://www.rcjournal.com.

  • Copyright © 2020 by Daedalus Enterprises
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Respiratory Care: 65 (11)
Respiratory Care
Vol. 65, Issue 11
1 Nov 2020
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Development of Quality Assurance and Quality Control Guidelines for Respiratory Oscillometry in Clinic Studies
Joyce KY Wu, Emily DeHaas, Richard Nadj, Aloysius Brandon Cheung, Ronald J Dandurand, Zoltán Hantos, Clodagh M Ryan, Chung-Wai Chow
Respiratory Care Nov 2020, 65 (11) 1687-1693; DOI: 10.4187/respcare.07412

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Development of Quality Assurance and Quality Control Guidelines for Respiratory Oscillometry in Clinic Studies
Joyce KY Wu, Emily DeHaas, Richard Nadj, Aloysius Brandon Cheung, Ronald J Dandurand, Zoltán Hantos, Clodagh M Ryan, Chung-Wai Chow
Respiratory Care Nov 2020, 65 (11) 1687-1693; DOI: 10.4187/respcare.07412
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Keywords

  • oscillometry
  • spirometry
  • plethysmography
  • quality improvement
  • practice guidelines
  • biological calibrations

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