One-stop neck lump clinic: phase 2 of audit. How are we doing?

Abstract

Regular monitoring and audit of a service are integral to ensuring maintenance of efficiency and standards. This is particularly important where the quality of the service is operator dependent, as is the case in the clinical diagnosis of neck lumps and fine needle aspiration cytology. The one-stop neck lump clinic has now been running in the department for more than 20 months. A previous article described the results of the first phase audit carried out at 6 months and had identified a waiting time to be seen that was longer than that recommended by the British Association of Otorhinolaryngologists, Head and Neck Surgeons. Measures were implemented to reduce this waiting time and a second audit was carried out after another 10 months with the aims of assessing if modification of the means of referral reduces waiting time and if the outcomes of clinical performance in phase 1 could be maintained or improved. We discuss the results of phase 2 in the audit spiral.

Management Pathways and the Surgical Diagnosis of Tuberculous Lymphadenitis: Can They Be Improved? The Bradford Experience

“…The present study offers support for arguments for a dedicated 'one-stop' neck lump clinic with easy access both from general practitioners and from other specialties within the hospital, staffed by clinicians familiar with head and neck disease, able to examine the oral cavity, nose, pharynx and larynx, able to carry out fine-needle aspiration and able to arrange early surgical biopsy without the need to refer to another colleague [7,8,16]. Surgical biopsy is ideally best carried out by a surgeon able to perform rigid upper aerodigestive endoscopy, should this be appropriate.…”

“…The study therefore shows that there is a need for a 'hospital' or 'trust' protocol for the management of cervical lymphadenopathy, which will allow appropriate and efficient diagnosis of common conditions and will ensure that mistakes and unnecessary delays are avoided [7,16]. The present study offers support for arguments for a dedicated 'one-stop' neck lump clinic with easy access both from general practitioners and from other specialties within the hospital, staffed by clinicians familiar with head and neck disease, able to examine the oral cavity, nose, pharynx and larynx, able to carry out fine-needle aspiration and able to arrange early surgical biopsy without the need to refer to another colleague [7,8,16].…”

Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

“…The original systematic review by Gagliardi et al 12 included twenty articles that described outcomes related to specific disease-site assessment units: eleven for breast cancer 4,[15][16][17][18][19][20][21][22][23][24] , three for colorectal cancer 7,25,26 , and six for head-and-neck cancer [31][32][33][34][35][36] . There were seventeen case series that involved 38-3119 patients, two rcts that included 478 and 791 patients, and one case-control study that included 177 cases and 162 controls 4,7,[15][16][17][18][19][20][21][22][23][24][25][26][31][32][33][34][35][36] .…”

“…There were seventeen case series that involved 38-3119 patients, two rcts that included 478 and 791 patients, and one case-control study that included 177 cases and 162 controls 4,7,[15][16][17][18][19][20][21][22][23][24][25][26][31][32][33][34][35][36] . The update of the literature search identified 823 citations in which patient outcomes related to diagnostic assessment units were described for colorectal cancer in four studies [27][28][29][30] , head-and-neck cancer in two studies 37,38 , lung cancer in two studies 39,40 , gynecologic cancers in three studies [41][42][43] , neurologic cancers in one study 44 , lymph node cancers in one study 45 , and upper gastrointestinal cancers in one study 46 .…”

The other side of the needle: A patient's perspective

“…Literature on patient customer satisfaction has resided mainly in the clinical arena. 3,4 Unlike the majority of the practice of Anatomic Pathology, the performance of FNA allows the pathologist to become directly involved in the pre-analytic process of patient care. As such, the patient becomes our primary customer.…”