title: One-stop thyroid nodule clinic with same-day fine-needle aspiration cytology improves efficiency of care.
abstract: BACKGROUND
  Thyroid nodules are a common presenting complaint for endocrine surgeons; many require ultrasound-guided fine-needle aspiration cytology (US-FNAC). In an attempt to streamline our service, we introduced same-day surgeon-performed US-FNAC in 2014.
  
  
  METHODS
  Three groups were defined: (A) retrospective group with FNAC performed in radiology prior to August 2014; (B) prospective radiology FNAC group; and (C) prospective surgeon-performed group. Demographics, nodule characteristics, pathology and management plans were recorded. The number and dates of hospital attendances were extracted from the patient information system.
  
  
  RESULTS
  Over 4 years, 635 patients underwent 757 FNACs. There were 438 patients in group A, 78 in group B and 119 in group C. Patient demographics and nodule size were similar between groups. Those patients undergoing FNAC in endocrine surgery clinic required two visits prior to receiving a diagnosis and management plan, compared with three visits for those performed in radiology. Non-diagnostic rates between three groups were 6.5%, 7.4% and 5.4% (P = 0.842) whilst malignant FNAC results occurred in 3%, 4% and 8% (P = 0.015) respectively. Median time from US-FNAC to definitive management plan was 42, 41 and 14 days (P < 0.001). The introduction of the one-stop clinic resulted in a 41% reduction of patients attending the radiology department for FNAC.
  
  
  CONCLUSIONS
  Surgeon-performed US-FNAC decreases the time from fine-needle aspiration request to definitive plan and reduces the number of patient visits, providing more efficient care. Patients referred to the endocrine surgery clinic with thyroid nodules have thyroid cancer more frequently than patients referred to radiology.
authors: Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Rajeshbhai
authors: R
authors: Patel
authors: Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors: Anita
authors: A
authors: R Skandarajah
authors: Melbourne Epicentre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Alexandra
authors: A
authors: Gorelik
authors: Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors: Matthew J
authors: MJ
authors: Shears
authors: Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors: Robert
authors: R
authors: Tasevski
authors: Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.|Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
authors: Julie A
authors: JA
authors: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D044963:Biopsy, Fine-Needle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000473:pathology* / Q000601:surgery
keywords: efficiency; fine needle; nodule; one-stop thyroid nodule clinic; surgeon-performed; thyroid