DELAYS IN SURGICAL REFERRAL AND TREATMENT OF ENDOCRINE DISEASES: A MIXED-METHODS ANALYSIS OF COMMUNICATION AND SYSTEM-LEVEL BARRIERS jk2157@georgetown.edu

396-08

DELAYS IN SURGICAL REFERRAL AND TREATMENT OF ENDOCRINE DISEASES: A MIXED-METHODS ANALYSIS OF COMMUNICATION AND SYSTEM-LEVEL BARRIERS

6

United States

Oral or Poster

Delays in care can lead to patient dissatisfaction, harm, and death. Effective communication is a crucial component of the diagnostic odyssey to ensure timely response, improve outcomes, and reduce adverse events.

This IRB-approved mixed-methods study was conducted at the MedStar Endocrine Surgery clinic. A retrospective review of 898 patient charts identified quantitative delays in referral (first abnormal lab or imaging to the first surgical consult) and delays in treatment (consult to surgery). Concurrently, 15 semi-structured interviews with English-speaking patients and staff explored barriers to timely endocrine surgical care. Transcripts were analyzed thematically.

The median delay in referral was 157 days (range: 10 - 6,101), and longer delays were associated with older age, thyroid disease, and female sex. The median delay in treatment was 62 days (range: 8 - 2,244), and longer delays were associated with older age, thyroid disease, female sex, African American race, and lack of enrollment in CRISP or Commonwell (DMV interoperability platform). Contributing qualitative factors included COVID-19, patient or clinic availability, misdiagnosis, and incidental findings. Communication methods included verbal discussions, phone calls, portal messaging, email, and Microsoft Teams. Effective communication featured active listening, proactive responsiveness, and personalized explanations. Barriers included poor anticipatory guidance, miscommunication, and inaccessible systems, each contributing to delays.

Delays in endocrine surgical care are multifactorial and often communication-driven. Improving referral workflows, expanding interoperability participation, and enhancing inter-professional coordination may reduce delays and improve patient outcomes.