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OBJECTIVES/HYPOTHESIS: To test our hypothesis that high-surgeon volume is associated with improved surgical efficiency and 30-day outcomes, and lower hospital utilization. STUDY DESIGN: Retrospective observational cohort, 2008-2013. METHODS: A total of 3,135 patients with hemithyroidectomy or total thyroidectomy performed by a high-volume surgeon, propensity score-matched to 3,135 patients with the same procedure performed by a low-volume surgeon. All-cause 30-day complication, mortality, readmission, and emergency department visit rates, proportion of outpatient procedures, cut-to-close time, and length of stay were assessed. RESULTS: Hemithyroidectomies: Compared to low-volume surgeons, high-volume surgeons had fewer readmitted patients (2.7% vs. 7.0%, P < .05), more outpatient procedures (46% vs. 29%, P < .05), and shorter lengths of stay (mean [standard deviation] 16.6 [22.1] vs. 21.7 [27.5] hours, P < .05) and surgical (cut-to-close) times (1.7 [0.7] vs. 2.0 [1.1] hours, P < .05). Total thyroidectomies: High-volume surgeons had lower rates of all surgery-related complications (5.7% vs. 7.5%, P < .05), hypocalcemia (4.9% vs. 7.0%, P < .05), surgical site infections (0.3% vs. 1.0%, P < .05), more outpatient procedures (13% vs. 3%, P < .05), shorter lengths of stay (29.9 [32.8] vs. 39.8 [36.2] hours, P < .05), and cut-to-close times (2.4 [1.1] vs. 3.0 [1.7] hours, P < .05). CONCLUSION: High-volume surgeons improve patient safety and have the potential to contribute to organizational efficiency that may be underutilized in some settings. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:2630-2639, 2016.

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OBJECTIVE: To test our hypothesis that general and thyroid surgery-specific complications, mortality, and postdischarge utilization for patients undergoing outpatient and inpatient thyroid and parathyroid surgery would not differ when outpatient status was defined as discharge within 8 hours of surgery completion. STUDY DESIGN: Retrospective observational cohort, 2008 to 2013. SETTING: Kaiser Permanente Northern California and Kaiser Permanente Southern California. SUBJECTS AND METHODS: We used a robust set of variables and propensity score methods to match 2362 patients undergoing hemithyroidectomy, total thyroidectomy, or parathyroidectomy surgery as outpatients to 2362 patients undergoing the same procedures as inpatients. Outcomes assessed were 30-day rates of complications, emergency department visits, all-cause hospital readmissions, and mortality. RESULTS: After matching, no statistically significant differences between inpatients and outpatients were found for complication rates or postdischarge utilization. After matching, there was no statistically significant difference between inpatients and outpatients in hematoma rates, which were 0.55% in both groups. In the matched-pair groups, 2 deaths occurred among inpatients (0.09%) and none occurred among outpatients (0.00%), a difference that was not statistically significant. CONCLUSION: Discharge within 8 hours after completion of thyroid and parathyroid surgery is as safe as inpatient surgery.

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OBJECTIVE: To assess associations between secure patient-clinician email use and clinical services utilisation over time. DESIGN: Retrospective cohort study between July 2010 and December 2013. Controlling for a utilisation surge around first secure email use, we analysed difference of differences between propensity score-matched groups of secure patient-clinician email users and non-users for utilisation 1-12 months before and 7-18 months after first email (users) or a randomly assigned index date (non-users). SETTING: US integrated healthcare delivery system. PARTICIPANTS: 9345 adults with first secure email use between July 2011 and July 2012 and continuous enrolment for ≥30 months and 9345 adults without secure email use between July 2010 and July 2012 matched to users on demographics, health status, and baseline utilisation. PRIMARY OUTCOME MEASURES: Rates of office visits, patient-initiated phone calls, scheduled telephone visits, after-hours clinic visits, emergency department visits, and hospitalisations. RESULTS: After controlling for multiple factors, no statistically significant differences in utilisation between secure email users and non-users occurred. Utilisation transiently increased by 88-237% around first email use. Annual rates of patient-initiated phone calls decreased among secure email users, 0.2 fewer calls per person (95% CI -0.3 to -0.1), from a mean of 4.1 calls per person 1-12 months before first use to a mean of 3.8 calls per person 7-18 months after first use. Rates of patient-initiated phone calls also decreased among non-users, 0.1 fewer calls per person (95% CI -0.2 to 0.0), from a mean of 4.2 calls per person 1-12 months before the index date to mean of 4.1 calls per person 7-18 months after the index date. CONCLUSIONS: Compared with non-users, patient use of secure email with clinicians was not associated with statistically significant differences in clinical services utilisation 7-18 months after first use.

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PURPOSE: Few organizations have reported providing radiology reports to patients via an electronic health record patient portal. The authors describe the process of manual release of reports made by referring physicians, and patients' and referring physicians' experiences during the first year that release through the portal was available. METHODS: A survey of 508 patients assessed perceived accessibility and importance of portal-released radiology reports, and communications with referring physicians before and after the release. A survey of 48 referring physicians and a group interview assessed the utility of releasing reports, preferences regarding automatic release, and workload impact. Data were analyzed using descriptive statistics and qualitative methods. RESULTS: A total of 74% (377) of patients found reports easy to access, and 88% (446) reported that the ability to do so was important. In all, 49% (250) of patients were contacted by their referring physician before report release, and 25% (156) contacted their physician for more information after viewing a report. Of the referring physicians, 88% (42) found that releasing reports to patients was useful. Auto-release of x-ray reports, with a 1-week delay, was preferred by 58% (28), but they were more reluctant to auto-release CT and MRI reports. A total of 86% (41) of referring physicians reported that follow-up emails, telephone calls, and office visits were unchanged or had decreased. CONCLUSIONS: Referring-physician release of radiology reports via the online portal is important to patients, useful to referring physicians, and does not affect referring-physician workloads. A delay between reporting results to referring physicians and releasing them to patients allows time for needed physician-patient communication.

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