Evidence-Based Workflows for Thyroid and Parathyroid Surgery

Association Between Annual Surgeon Total Thyroidectomy Volume and Transient and Permanent Complications

“…Although we located a single report of a paradoxical association between greater surgeon experience in years and patient outcomes, previous studies have concluded that surgeon procedure volumes are uniformly associated with better patient outcomes, which appears to confirm our assumption that the single surgeon we observed with higher complication rates represented an outlier and should be excluded. We note that the observation period preceded a concerted effort across Kaiser Permanente to consolidate care for patients with thyroid nodules to higher-volume surgeons and the dissemination of multidisciplinary workflows based on the 2015 American Thyroid Association guidelines …”

American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence‐based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules

“…As implementation continued, additional CME events were modified to reflect any changes in the workflows, reinforce collaboration across the specialties, and demonstrate how workflows are based on CPGs. At KPNC, an in‐house medical journal published the workflows to facilitate their distribution prior to the launch . In addition, after implementation at KPNC, a performance improvement team using tools based on human‐centered design interviewed physicians, nurses, and patients to further assure a collaborative approach to the workflows and patient‐centered decision making regarding disposition following surgery, including same‐day discharge.…”

“…A subgroup of 10 coauthors (B.M., C.M., E.M., G.R., J.M., J.J.S., J.I., L.D., M.O., and L.G.T.M.) identified topics for statements that would undergo consensus development, taking into consideration existing and planned quality metrics at KPNC and COO . Twelve metrics common to the two systems were included, along with five others (antibiotic use, 30‐day mortality rates, postoperative voice evaluation, preoperative calcium level, and outpatient surgery) that were unique to KPNC.…”

“…identified topics for statements that would undergo consensus development, taking into consideration existing and planned quality metrics at KPNC and COO. 22,23 Twelve metrics common to the two systems were included, along with five others (antibiotic use, 30-day mortality rates, postoperative voice evaluation, preoperative calcium level, and outpatient surgery) that were unique to KPNC. The subgroup had considered an abbreviated list of metrics but included all 17 to enhance tailoring to local care settings.…”

“…At KPNC, an in-house medical journal published the workflows to facilitate their distribution prior to the launch. 23 In addition, after implementation at KPNC, a performance improvement team using tools based on human-centered design interviewed physicians, nurses, and patients to further assure a collaborative approach to the workflows and patient-centered decision making regarding disposition following surgery, including same-day discharge. CCO completed review in its 14 regions before finalizing and distributing care paths though Community of Practice events.…”