Improving access to the Endocrine Clinic in a teaching hospital for patients with thyroid dysfunction

Thyroid disease is very common with thyroid dysfunction affecting approximately 4% of the population. In many cases, specialist opinion is required to effectively manage patients with thyroid dysfunction who may often wait long periods of time to access specialist care, due to the prevalence of conditions and competing clinical requirements, especially from people with diabetes. Most endocrine services cannot see patients with thyroid dysfunction as often as indicated by international guidelines. In the thyroid clinic studied in February 2017, it was found that the waiting time for new referrals was 12 weeks, while return patients waited 14 weeks on average to be seen at the thyroid clinic. This means that patients with hypothyroidism- and hyperthyroidism cannot be seen following treatment commencement in 2-6 (hypothyroid) or 3-4 (hyperthyroid) weeks as recommended. This project addresses the factors contributing to this delay. Using a Define, Measure, Analyse, Improve and Control (DMAIC) approach, a Plan Do Study Act (PDSA) cycle is proposed to improve an access to the endocrine clinic for patients with thyroid dysfunction. Identifying that the frequency of thyroid clinics does not allow the service to meet guidelines, it is proposed to introduce a “virtual” thyroid clinic which will be consultant-delivered. Patients’ laboratory data, treatment regimen and clinic notes will be reviewed at a once monthly clinic where the patients will not be in attendance and treatment decisions will be communicated to patients. The aim of this quality improvement intervention is to shorten the wait time for return patients by two months over the first year.