Objectives:   Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield  Short Term\u3ereduce unsuccessful biopsies by 50%   Long-Term\u3eeliminate unsuccessful biopsieshttps://jdc.jefferson.edu/patientsafetyposters/1064/thumbnail.jp

McKee, MD, T. Conor

Roth, MD, MS-HQS, Christopher G.

English

Objectives:   Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield  Short Term\u3ereduce unsuccessful biopsies by 50%   Long-Term\u3eeliminate unsuccessful biopsieshttp://jdc.jefferson.edu/patientsafetyposters/1064/thumbnail.jp

Name not available

Increasing Ultrasound-Guided Thyroid Biopsy Yield

Jefferson Digital Commons

Thomas Jefferson UniversityJefferson Digital CommonsHouse Staff Quality Improvement and PatientSafety Posters GME Quality and Safety5-31-2017Increasing Ultrasound-Guided Thyroid BiopsyYieldT. Conor McKee, MDThomas Jefferson University, conor.mckee@jefferson.eduChristopher G. Roth, MD, MS-HQSJefferson College of Population Health, Thomas Jefferson University, christopher.roth@jefferson.eduFollow this and additional works at: http://jdc.jefferson.edu/patientsafetypostersPart of the Medicine and Health Sciences CommonsLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inHouse Staff Quality Improvement and Patient Safety Posters by an authorized administrator of the Jefferson Digital Commons. For more information,please contact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationMcKee, MD, T. Conor and Roth, MD, MS-HQS, Christopher G., "Increasing Ultrasound-Guided Thyroid Biopsy Yield" (2017).House Staff Quality Improvement and Patient Safety Posters. Poster 44.http://jdc.jefferson.edu/patientsafetyposters/44Increasing Ultrasound-Guided Thyroid Biopsy Yield Team Member: T. Conor McKee, MDFaculty Mentor: Christopher G Roth, MD, MS-HQS➢Thyroid nodules are a very common ultrasound findingPrevalence of up to 68%5-15% of these are malignant and many require biopsy by fine needle aspiration (FNA)➢Rate of inadequate biopsy varies widely despite ultrasound guidance (59.3%-99.6%)➢Two modifiable factors are consistently identified which improve thyroid biopsy yieldOperator experienceCytopathology involvement➢ Obtaining adequate biopsies can impact patient care➢ Eliminate need for additional invasive procedures➢ Eliminate need for follow up imaging➢ Decrease anxiety associated with an indeterminate biopsy resultBackground➢Prior to implementation the adequate thyroid biopsy rate was approximately 90%➢Average of 9 patients per year with inadequate➢In the first two quarters of FY 2016 there were 1 and 0 inadequate biopsies, respectively (100%, 97.6%)➢Fallout  unexpected lack of tele-cytopathology➢Unsuccessful biopsies reviewed for underlying causal factors➢2 major factors  1) lack of cytology availability and 2) operator variability➢Schedule adjusted to accommodate all patients into thyroid clinic conducted by single subspecialist➢Coordination with TJUH pathology department to provide tele-cytopathology services for review of all ultrasound guided thyroid biopsies.➢Resident team member collects and analyzes inadequate thyroid biopsies for future improve ent events (PDSA)Methods and Materials➢ In the first two quarters since quality improvement measures have been implemented there has been improvement in the the rate of successful biopsies➢Leveraging provider experience can provide improved care patient care➢Standardizing the approach improves team performanceSupport staff better understand their role with less variability on the part of the proceduralist➢Inter-disciplinary collaboration and technology leveraging allow involvement of cytopathology increases adequate biopsy yieldSignificance/Lessons LearnedResultsGraph 1. Thyroid Biopsy Successful Sample Rate.Graph 2. MHD Thyroid Biopsy Volume.87.90%94.90%86.50%100%97.60%75.00%80.00%85.00%90.00%95.00%100.00%105.00%FY15Q2 FY15Q3 FY15Q4 FY16Q1 FY16Q2Successful Sample332722 22162320 204629373224412303430 104250105101520253035404550FY13Q1 FY13Q2 FY13Q3 FY13Q4 FY14Q1 FY14Q2 FY14Q3 FY14Q4 FY15Q1 FY15Q2 FY15Q3 FY15Q4 FY16Q1 FY16Q2Successful Samples Unsuccessful BiopsiesGharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules : executive summary of recommendations. Endocr Pract. 2010; 16: 468–475.Berner A, Sigstad E, Pradhan M, Grøholt KK, Davidson B. Fine-needle aspiration cytology of the thyroid gland: comparative analysis of experience at three hospitals. Diagn Cytopathol. 2006; 34: 97–100.Guth S, Theune U, Aberle J, Galach A, Bamberger CM. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009; 39: 699–706.American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Cooper DS, Doherty GM, Haugen BR, KloosRT, Lee SL, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19: 1167–1214.Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med. 2004; 351: 1764–1771.Degirmenci B, Haktanir A, Albayrak R, Acar M, Sahin DA, Sahin O, et al. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material. Clin Radiol. 2007; 62: 798–803.Objectives➢Conduct Plan-Do-Study-Act (PDSA) performance improvement project to improve thyroid biopsy yield➢Short-term  reduce unsuccessful biopsies by 50%➢Long-term  eliminate unsuccessful biopsiesChoi SH, Han KH, Yoon JH, Moon HJ, Son EJ, Youk JH, et al. Factors affecting inadequate sampling of ultrasound-guided fine-needle aspiration biopsy of thyroid nodules. Clin Endocrinol (Oxf) 2011; 74: 776–782.De Fiori E, Rampinelli C, Turco F, Bonello L, Bellomi M. Role of operator experience in ultrasound-guided fine-needle aspiration biopsy of the thyroid. RadiolMed. 2010; 115: 612–618.Alexander EK, Heering JP, Benson CB, Frates MC, Doubilet PM, Cibas ES, et al. Assessment of nondiagnostic ultrasound-guided fine needle aspirations of thyroid nodules. J Clin Endocrinol Metab. 2002; 87: 4924–4927.Mahony GT, Mahony BS. Low nondiagnostic rate for fine-needle capillary sampling biopsy of thyroid nodules: a singular experience. J Ultrasound Med. 2013; 32: 2155–2161.Gursoy A, Anil C, Erismis B, Ayturk S. Fine-needle aspiration biopsy of thyroid nodules: comparison of diagnostic performance of experienced and inexperienced physicians. Endocr Pract. 2010; 16: 986–991.Choi YS, Hong SW, Kwak JY, Moon HJ, Kim EK. Clinical and ultrasonographic findings affecting nondiagnostic results upon the second fine needle aspiration for thyroid nodules. Ann Surg Oncol. 2012; 19: 2304–2309.Future Direction➢Continue to analyze adequate biopsy rates to verify improvement (PDSA)➢Periodically review fallouts to identify common cause to implement future improvements (PDSA)interventionintervention

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Increasing Ultrasound-Guided Thyroid Biopsy Yield

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