Endocrine Abstracts

Introduction: Quality Improvement Projects (QIPs) aim to enhance patient outcomes, safety, and efficiency through systematic process improvements. This QIP, conducted at a secondary care centre, evaluated the adrenal service by streamlining the patient pathway from multidisciplinary team (MDT) referral to clinic appointment or discharge.

Methods: A retrospective analysis was conducted on 144 patients referred to the adrenal MDT between January and July 2024. Data on demographics, comorbidities, lesion type, and investigation outcomes were collected. Key metrics included time from MDT referral to initial adrenal work-up, time to first specialist appointment, discharge rates, requirements for repeat work-up, and referrals to the tertiary adrenal MDT for further opinion or surgery.

Results: Of the 144 patients, 52% were female, with a mean age of 64.6 years (range 19–94). Adrenal work-up was completed within five months in 71.5% of cases, including 26% at the time of the MDT. The average time from MDT to clinic review was 6.6 months, although patients with large indeterminate lesions were prioritised. Over half (54%) were discharged following initial work-up without requiring a clinic visit; 40% were discharged after one follow-up, and 6% after two. The most common diagnosis was benign non-functioning adenoma (73.4%), followed by phaeochromocytoma (4%) and mild autonomous cortisol secretion (MACS) (6%). Repeat imaging was required in 33 cases (with additional plain CT, MIBG, or PET-CT), and 9% were referred to the tertiary MDT. Notably, 47% had both diabetes and hypertension, and 33 normotensive patients with radiologically benign lesions underwent renin/aldosterone testing—suggesting potential overuse of investigations.

Conclusions/recommendations: Recommendations included a pre-MDT checklist, registrar-led scan requests, template letters, and standardised post-MDT processes to create a virtual discharge pathway. These interventions aim to reduce waiting times, minimise unnecessary investigations, optimise resources, and ultimately improve patient outcomes.