Impact of Electronic Consultation on Timeliness and Guideline Concordance of Workups Leading to Thyroid Nodule Fine-Needle Aspiration Biopsy.

Yoon SS, Wong DH, Wormwood JB, Reisman JI, Vimalananda VG. Impact of Electronic Consultation on Timeliness and Guideline Concordance of Workups Leading to Thyroid Nodule Fine-Needle Aspiration Biopsy. Endocrine Practice : Official Journal of The American College of Endocrinology and The American Association of Clinical Endocrinologists. 2021 Oct 1; 27(10):1011-1016.

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Abstract:

OBJECTIVE: Electronic consultations (e-consults) are commonly used to obtain endocrinology input on clinical questions without a face-to-face visit, but sparse data exist on the resultant quality of care for specific conditions. We examined workups resulting in a thyroid nodule fine-needle aspiration (FNA) biopsy to investigate whether endocrinology e-consults were more timely and similarly guideline-concordant compared with endocrinology face-to-face visits and whether endocrinology e-consults were more guideline-concordant compared with workups without endocrinology input. METHODS: We retrospectively reviewed charts of 302 thyroid FNA biopsies conducted in the Veterans Affairs health system between May 1, 2017, and February 4, 2020 (e-consult, n  = 99; face-to-face visit, n  = 100; no endocrinology input, n  = 103). We used t tests to compare timeliness, ? tests to compare the proportion of guideline-concordant workups, and multivariable linear and logistic models to control for demographic factors. RESULTS: FNAs preceded by an endocrinology e-consult had more timely workups compared with those preceded by endocrinology face-to-face visits in terms of days elapsed between referral and FNA biopsy (geometric mean 44.7 days vs 61.7 days, P  = .01). The difference in the summary measure of guideline concordance across groups was not statistically significant (P  = .38). CONCLUSION: E-consults were faster than face-to-face consults and similarly guideline-concordant compared with both face-to-face consults and no endocrinology input for workups resulting in FNA. Decisions about the appropriate use of e-consults for thyroid nodules should take into account these data while also considering the potential benefits of direct patient-endocrinologist interaction for complex situations.