Impact of a Resident-Driven Quality Improvement Project on Incidental Thyroid Nodule Follow-up-A Single Center Study

Incidental thyroid nodules (ITNs) are frequently detected during unrelated imaging studies and an estimated 4% are potentially malignant. The American College of Radiology provides guidelines for ITN characterization and follow-up, but awareness and adherence are inconsistent. Limited studies exist to evaluate the impact of structured ITN management guidelines on primary care providers' (PCPs) follow-up on clinical outcomes. This study assessed the effect of a resident-driven quality improvement (QI) initiative on ITN reporting accuracy and PCP follow-up adherence.

This resident-led QI initiative spanned two academic years and was implemented in two phases. Phase one (2022-23) standardized reporting using dictation templates. Phase two (2023-24) implemented monthly chart audits to identify ITNs unknown to PCPs and secure messaging to encourage follow-up. Outcomes included PCP awareness, thyroid ultrasounds, biopsies, and surgeries.

Post-intervention, PCP awareness of ITNs increased significantly from 75% to 98% (p=0.0005). Patients receiving recommended follow-up thyroid ultrasounds rose from 40% to 59% (p=0.04). Although increases in fine needle aspiration rates detection were observed, these changes were not statistically significant.

This study highlights the effectiveness of a resident-led QI initiative in improving ITN follow-up adherence. Standardized reporting and targeted PCP notifications addressed critical care gaps and promoted a culture of continuous quality improvement. This study provides a scalable framework of workflow interventions that can optimize management of incidental findings and improve patient care.