New GIRFT report seeks to improve endocrine patient care

GIRFT is a project designed to address differences between hospitals in the quality of outcomes after medical and surgical treatments. Consultant endocrinologist, Prof John Wass and consultant endocrine surgeon, Mr Mark Lansdown, worked with the GIRFT team to produce the report.  The new GIRFT report on endocrinology makes 17 important recommendations to improve patient care. These include:

  • Patients receive thyroid surgery from high-volume surgeons as this has been linked to better patient outcomes
  • Surgeons performing endocrine surgery submit their outcomes to the British Association of Endocrine and Thyroid Surgeons (BAETS) electronic UK Registry of Endocrine and Thyroid Surgery (UKRETS)
  • Lengths of stay for surgical procedures are reduced, where clinically appropriate
  • Deliver networked service models so that patients can be referred to the most appropriate surgeon and the correct level of care.

We were invited to give our input as one of the stakeholder organisations and are delighted that some of our comments, particularly around ensuring patients receive the right information and support, are included in the report.

Mark Lansdown, explains more:

I have had the pleasure of working with Prof John Wass and the GIRFT team writing the Endocrinology report. Prof Wass visited every endocrinology department in England to discuss what can be done to improve the care of patients with endocrine disorders. With the GIRFT team we then analysed the data collected for those visits alongside national data that records admission and discharges, number of outpatient visits and much more. My role in this was to help analyse outcomes of thyroid, parathyroid and adrenal surgery and to make recommendations to make the service as good as it can be wherever patients are treated.

We are asking trusts to ensure all patients are treated by surgeons who do at least 20 thyroid operations a year. Most patients needing thyroid surgery will still be treated locally but some, for example with medullary thyroid cancer, are undoubtably best treated in high volume cancer centres where the experienced thyroid surgeons have the support of specialists in endocrinology, oncology, radiology and genetics.

There is no doubt in my mind that the data show a relationship between surgeon experience and outcomes. For instance, if you have a total thyroidectomy for Graves’ disease and are under the care of a surgeon who is doing one or more thyroid operations a week you are likely to have a shorter hospital stay and a lower risk of complications (such as hypoparathyroidism) than if treated by a surgeon who does just one thyroid operation a month. However, some busy surgeons have more complications than others and some surgeons who do the minimum recommended number of 20 cases a year still get good results.

Where does this leave you as a patient? It is perfectly acceptable to ask your surgeon how many cases they do a year and whether they compare their results with those of other thyroid surgeons regularly by participating in audit. When a surgeon quotes the risk of a complication ask if that is their estimate of your personal risk and whether their answer is based on their own results or average results across the country. A surgeon prepared to listen to their patients should not be upset by such questions. We have recommended that all surgeons performing endocrine surgery submit their outcomes to a national register and that they are given time to do so in their job plans. This is to make it easier for them to answer your questions and of course to reflect on the quality of their outcomes! 

Mark Lansdown, September 2021

Thank you to Prof John Wass, Mr Mark Lansdown and the GIRFT team for their work on this report. We very much hope their recommendations will lead to improvements in patient care and outcomes.

Read the GIRFT report

Read the BAETS surgeon specific outcomes report

BTF thyroid surgery information   

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