1. Improving diagnostic services for patients attending Outpatient Thyroid clinics Mr Vijay Kurup Consultant Surgeon Karen Milburn Specialist Nurse Lynn Armstrong OPD Matron

2. Background Thyroid service integral part of North of England Cancer Network Weekly thyroid outpatient clinic Dedicated Team providing diagnostic and treatment service for thyroid cancer.

3. Reason for improvement FNAC is the main diagnostic procedure. Fine needle biopsy performed free hand, by all grades in outpatient clinic. Inadequate sample main problem.. (THY1). FNA needs frequently repeated.

4. Observation & Develop a New Vision DO ACT PLAN CHECK Awareness- A Change In Practice Clinical Audit Plan a change in service Give it a try DO ACT PLAN STUDY Study the results

5. New measures US guided FNAC by one dedicated radiologist. Analysis of specimen by one dedicated pathologist.

6. Difficulties Discussions with Clinical directors&managers Any willing radiologist? Funding issues. Sessional committment from radiologist/CD radiology to meet time limits/targets

7. Solutions One radiologist agreed. Funding was never agreed;but happened. One pathologist agreed. Now every FNA is done with the help of US guidance by dedicated radiologist. Our FNA accuracy is now better than national average.

8. THY1 Audit Results Before improvement THY1 rate = 52.1% One year After Improvement THY1 rate = 30.2%(Re audit) Currently about 20%

9. Conclusion Revised diagnostic sampling procedure successful Commitment and support for its implementation Recommendation…. A One Stop clinic for patients