Endocrine Abstracts

Introduction: A Nurse-led Thyroid Clinic (NLTC) in a tertiary-care Endocrinology centre (EC) in Oxford was set up in 2005. The patients were managed by an Endocrine Advanced Nurse Practitioner.

Aims: To evaluate standard of clinical care (SOCC) quality of service provision (QOSP) and cost effectiveness (CE) of the NLTC.

Methods: Three aspects of service were assessed:

a) SOCC: Data were collected for patients managed over 12 months between 1/2014 and 1/2015. Diagnosis, investigations and management plans for individual patients were compared against accepted regional and national guidelines.

b) QOSP was evaluated from standardised patient feedback questionnaires (PFQ) that were anonymised for confidentially

c) CE was analysed through collection of retrospective data of filed patients clinic lists between 1/2014 and 1/2015. A new patient (NP) tariffed at £120, follow-up, at £90 per visit according to finance department protocol. Annual data recorded of non-face-to-face-telecommunication (NFTFT) costed at £30 per call.

Results:

a) SOCC: 214 patient appointments for 134 patients were reviewed; 112 patients had Graves’ disease, 10 subacute thyroiditis,10 toxic nodular diseases and two subclinical thyrotoxicosis. Patients were managed with a departmental protocol based on British Thyroid Association guidelines 2006.

b) QOSP: 50 out of 60 PFQ were returned (34 women/16 men, median age 52.3 years, range 21–85). Majority of the patients expressed high satisfaction with the quality of services provided, with 86% “Extremely Likely” to recommend the TNLC to friends and family.

c) CE: New and follow-up patients generated an annual income of £20,490. NFTFT calls (908 patients) generated an income of £27,240. 41 empty NP clinic slots, 22 follow up cancellations and 19 patients who failed to attend the clinic, amounted to a loss of £8610.

Conclusions: The audit supports the value of NLTCs in EC’s with a significant thyroid-dysfunction workload. These clinics can provide high quality of clinical care and potentially be cost-effective.