Page 123 - Hospital Authority Convention 2017

Service Enhancement Presentations

F1.5 Better Manage Growing Service Demands 10:45 Room 421

Thyroid Triaging Programme for Early Diagnosis, Timely Referral, and Prompt Management of Thyroid Diseases
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Loong CHN , Woo YC , Lam JKY , Leung ELY , Yuen MMA , Lui DTW , Lee PCH , Lee ACH , Tan KCB , Lam KSL 2
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Department of Medicine, Queen Mary Hospital, Department of Medicine, The University of Hong Kong, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
Introduction
New case referrals to medical thyroid specialist outpatient clinic have increased from 198 to 412 cases annually from 2010
to 2016. The new case waiting time has increased alarmingly from 18 to 35 weeks despite the provision of extra quota. To
address the growing demand of service, a new two-step triage system, the Thyroid Triaging Programme (TTP), has been
piloted since 2015.
Objectives
To evaluate the effectiveness of TTP, and (2) to monitor the new case waiting time of high risk patients in thyroid clinic.
Methodology
Patients referred to thyroid medical specialist outpatient clinic between October 2015 and October 2016 were assessed in
the TTP. Patients were triaged to high-risk, potential high-risk and low-risk groups based on various criteria, including their
latest clinical and biochemical information. While high-risk and low-risk patients were offered early and routine appointment
respectively, potential high-risk subjects were assessed in a nurse-led clinic, where patients’ clinical information was
gathered and verified using the hospital’s Computer Medical System. Further investigations including blood tests, ultrasound
and thyroid scan, as well as early clinic appointment were arranged for indicated patients according to a pre-defined
protocol. Medications would be initiated and titrated by an endocrinologist when necessary. Those who did not need such
interventions would be provided routine clinic appointment. Tuesday, 16 May

Results
412 patients were referred to thyroid specialist outpatient clinic during the mentioned period. The mean age of patients
was 46±15 years. Among the new case referrals, 123 (29.9%) were triaged to high-risk group, 70 (16.9%) to potential-high-
risk group, and 219 (53.2%) to low-risk group. Among the potential high-risk group, 58 (82.2%) patients required further
investigations including thyroid scan (n=14, 24.1%) and fine needle aspiration of thyroid (n=10, 17.2%). 48 (68.5%) patients
initiatied anti-thyroid drugs and/or required dosage titration. 49 (70.0%), 11 (15.7%) and six (8.5%) patients had Graves’
disease, multi-nodular goiter and thyroiditis respectively. Three (4.2%) cases of thyroid cancer, and incidentally, three non-
thyroid diseases, one lung cancer, one thymic cancer, and one Cushing’s syndrome were diagnosed early through this
programme. They were referred to appropriate specialties for further management. The clinic waiting time for the potential
high-risk group who needed early medical attention was significantly shortened compared with the low-risk group (7±3
vs.35±14 weeks, p<0.001).

The TTP demonstrated an effective model to enhance the provision of specialist service to indicated patients in a more timely
and efficient way. It facilitated early medical decision as investigation results had been ready in the first clinic consultation.
The nurse-led clinic in this programme facilitated early identification of high-risk patients and shortened their waiting time.
Extending the nurse-led clinic coverage to all new referrals is worthy of consideration.

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