title: Does thyroid subspecialization alter practice and outcome? A completed 4-year audit loop.
abstract: OBJECTIVE
  To assess the effect of subspecialization on thyroid surgical practice and outcome.
  
  
  METHODS
  The multidisciplinary thyroid clinic was established in November 2000. A retrospective study of all thyroid surgery covering the period November 1998 to November 2000 was carried out. Best practice principles were implemented and prospective data were collected over a further 2 years to complete the audit loop. Practice and results were compared.
  
  
  METHODS
  The project was carried out through the Hull and East Yorkshire Multidisciplinary Thyroid Clinic, a tertiary referral clinic for the management of thyroid disease.
  
  
  METHODS
  All patients who underwent thyroid surgery through the Department of Otolaryngology Head and Neck Surgery for 2 years before the establishment of the thyroid clinic (39 patients) and all patients who underwent thyroid surgery through the department for 2 years after the establishment of the clinic (108 patients) were included.
  
  
  METHODS
  Referral patterns, preoperative workup, types of surgery, histopathological diagnosis and complications rates were compared.
  
  
  RESULTS
  The audit loop revealed that permanent vocal cord palsy rates had fallen from 8% to 0%, haematoma rates had fallen from 5% to 2% and permanent hypoparathyroidism rates had fallen from 8% to 2%. In addition, caseload had markedly increased, preoperative investigations were reduced and types of surgery standardized.
  
  
  CONCLUSIONS
  It is clear that thyroid subspecialization is beneficial as far as overall outcome is concerned. However, this may lead to increased throughput which must be borne in mind for future activity planning.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, Hull Royal Infirmary, Hull, UK. fagada@aol.com
authors.forename: F O
authors.initials: FO
authors.lastname: Agada
authors.forename: J U
authors.initials: JU
authors.lastname: King-Im
authors.forename: S L
authors.initials: SL
authors.lastname: Atkin
authors.forename: R J A
authors.initials: RJ
authors.lastname: England
mesh_terms: D000554:Ambulatory Care Facilities; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006782:Hospitals, Special; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000628:therapy; D007037:Hypothyroidism / Q000453:epidemiology / Q000628:therapy; D008485:Medical Audit; D008511:Medicine; D010036:Otolaryngology; D017063:Outcome Assessment, Health Care; D011182:Postoperative Care; D011183:Postoperative Complications; D011300:Preoperative Care; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D013959:Thyroid Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D013965:Thyroidectomy; D006113:United Kingdom