Adrenal lesions found incidentally: how to improve clinical and cost-effectiveness

BMJ Open Quality

article

Fahmy W F Hanna¹  Basil G Issa³  Simon C Lea⁴  Cherian George⁵  Anurag Golash⁶  Mike Firn⁷  Seyi Ogunmekan⁸  Elloise Maddock⁹  Julius Sim^1,10  Georgios Xydopoulos^1,11  Richard Fordham^1,11  Anthony A Fryer^1,12 

[1] Department of Diabetes and Endocrinology , University Hospitals of North Midlands NHS Trust;Centre for Health and Development , Staffordshire University;Department of Diabetes and Endocrinology , University Hospital of South Manchester NHS Foundation Trust;Research and Innovation Directorate , University Hospitals of North Midlands NHS Trust;Imaging , University Hospitals of North Midlands NHS Trust;Department of Urology , University Hospitals of North Midlands NHS Trust;Springfield Consultancy , South West London and Saint George’s Mental Health NHS Trust;Furlong Medical Centre;Department of Information and Communications Technology , University Hospitals of North Midlands NHS Trust;School of Primary, Community and Social Care , Keele University;Department of Health Economics , University of East Anglia;Department of Clinical Biochemistry , University Hospitals of North Midlands NHS Trust

关键词: cost-effectiveness;    continuous quality improvement;    Decision support;    computerised;    Diagnostic errors;    Healthcare quality improvement;   

DOI  :  10.1136/bmjoq-2018-000572

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Introduction Adrenal incidentalomas are lesions that are incidentally identified while scanning for other conditions. While most are benign and hormonally non-functional, around 20% are malignant and/or hormonally active, requiring prompt intervention. Malignant lesions can be aggressive and life-threatening, while hormonally active tumours cause various endocrine disorders, with significant morbidity and mortality. Despite this, management of patients with adrenal incidentalomas is variable, with no robust evidence base. This project aimed to establish more effective and timely management of these patients.Methods We developed a web-based, electronic Adrenal Incidentaloma Management System (eAIMS), which incorporated the evidence-based and National Health Service–aligned 2016 European guidelines. The system captures key clinical, biochemical and radiological information necessary for adrenal incidentaloma patient management and generates a pre-populated outcome letter, saving clinical and administrative time while ensuring timely management plans with enhanced safety. Furthermore, we developed a prioritisation strategy, with members of the multidisciplinary team, which prioritised high-risk individuals for detailed discussion and management. Patient focus groups informed process-mapping and multidisciplinary team process re-design and patient information leaflet development. The project was partnered by University Hospital of South Manchester to maximise generalisability.Results Implementation of eAIMS, along with improvements in the prioritisation strategy, resulted in a 49% reduction in staff hands-on time, as well as a 78% reduction in the time from adrenal incidentaloma identification to multidisciplinary team decision. A health economic analysis identified a 28% reduction in costs.Conclusions The system’s in-built data validation and the automatic generation of the multidisciplinary team outcome letter improved patient safety through a reduction in transcription errors. We are currently developing the next stage of the programme to proactively identify all new adrenal incidentaloma cases.

【 授权许可】

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