Quality in Primary Care Open Access

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Quality of thyroid referrals in Saskatchewan

Kerollos Wanis, Jennifer Oucharek, Gary Groot

Background A thyroid nodule is a common presentation for thyroid pathology. A low proportion of thyroid nodules harbour malignancy and the investigation of these nodules should be performed in a cost-effective manner. The American Thyroid Association (ATA) has published guidelines which  should aid physicians in performing the appropriate investigations. AimTo determine the proportion of patients referred to thyroid surgeons in Saskatchewan with appropriate pre-referral work-up. MethodsData were retrospectively collected from the charts of all new thyroid referrals seen between 8 June 2011 and 8 June 2012 by two thyroid surgeons in the Saskatoon Health Region, Saskatchewan, Canada. Main outcome measures were the presence of thyroid stimulating hormone (TSH) and ultrasound results, and the appropriateness of ultrasound report recommendations in referrals to thyroid surgeons. ResultsRecent TSH results were done and sent to the thyroid surgeon in 55.1% of referrals. A recent ultrasound was performed in 92.3% of referrals. Of patients with a high or normal TSH, a radionuclide scan was inappropriately recommended in 11.5%of cases. ConclusionThere is room for improvement in pre- eferral work-up of patients with thyroid nodules in Saskatchewan, in order to facilitate appropriate clinical decision making in a cost-effective manner.