No abstract

Handoff communication deficiencies between the emergency department (ED) and primary care have been recognized as the result of delays and/or omissions in follow-up care for patients. This quality improvement project addresses the gaps in follow-up care for patients with low-risk chest pain by implementing an electronic Emergency Provider Written Plan of Discharge (eEPWPD) template to notify primary care providers (PCPs) that follow-up care is needed for their patients. This retrospective study evaluated effectiveness of the template in providing additional diagnostic and follow-up care. Results indicated that following the implementation of the eEPWPD template, follow-up for this population increased significantly. This study provides evidence that standardizing handoff communication from the ED to PCP can improve the quality of patient care by ensuring timely diagnostic and follow-up care.

Objectives: To compare diagnostic performance of British Thyroid Association (BTA), American College of Radiology Thyroid Imaging Reporting and Data System (ACR-TIRADS) and Artificial Intelligence TIRADS (AI-TIRADS) for thyroid nodule malignancy. To determine comparative unnecessary FNA rates. Methods: 218 thyroid nodules with definitive histology obtained during 2017 were included. Ultrasound (US) images were reviewed retrospectively in consensus by two subspecialist radiologists, blinded to histopathology, and nodules assigned a BTA, ACR-TIRADS and AI-TIRADS grade. Nodule laterality and size were recorded to allow accurate histopathological correlation and determine which nodules met criteria for fine needle aspiration (FNA). Results: 77 (35.3%) nodules were malignant. Deeming US Grade 4–5 as test-positive and 1–2 as test-negative, sensitivity and specificity for BTA was 98.28 and 42.55%, for ACR-TIRADS: 95.24 and 40.57% and for AI-TIRADS: 93.44 and 45.71%. FNA was indicated in 101 (71.6%), 67 (47.5%) and 65 (46.1%) benign nodules utilizing BTA, ACR-TIRADS and AI-TIRADS respectively. The unnecessary FNA rate was significantly higher with BTA (46.3%) compared to ACR-TIRADS (30.7%) and AI-TIRADS (29.8%) p < 0.001. Conclusion: BTA, ACR-TIRADS and AI-TIRADS had similar diagnostic performance for predicting thyroid nodule malignancy with sensitivity >93% for all systems when considering US Grade 4–5 as malignant and Grade 1–2 as benign. ACR-TIRADS and AI-TIRADS both had a significantly lower rate of recommended FNA in benign nodules compared to BTA. Advances in knowledge: BTA, ACR-TIRADS and AI-TIRADS have comparable diagnostic performance with high sensitivity but relatively low specificity for predicting thyroid nodule malignancy in this cohort using histology as gold standard. Using Grade 1–2 as benign and 4–5 as malignant there were more false negatives with TIRADS but this improved when taking other features into account while BTA had a significantly higher rate of unnecessary FNA. Comparison of British Thyroid Association, American College of Radiology TIRADS and Artificial Intelligence TIRADS Ultrasound Grading Systems with Histological Correlation: Diagnostic Performance for Predicting Thyroid Malignancy and Unnecessary Fine Needle Aspiration Biopsy Rate