ORGANIZATIONAL MODELS OF “ONE-STOP” CLINICS FOR THYROID DISEASE: A REVIEW OF PROCESSES, PERFORMANCE INDICATORS, AND OUTCOMES FROM THE LITERATURE

Marko Kimi Milić; Šćepan Sinanović; Dejan Kostić; Milena Ratković

Marko Kimi Milić High Medical College of Professional Studies „Milutin Milanković”, Belgrade, Serbia https://orcid.org/0009-0007-1308-7220
Šćepan Sinanović High Medical College of Professional Studies „Milutin Milanković”, Belgrade, Serbia https://orcid.org/0000-0002-8125-7873
Dejan Kostić Univerity of Defence in Belgrade, Medical Faculty of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy in Belgrade, Institute of Radiology, Belgrade, Serbia https://orcid.org/0000-0002-4420-6348
Milena Ratković Military Medical Academy, Belgrade, Serbia

Keywords: one-stop clinic; thyroid; ultrasound; fine-needle aspiration; ROSE; TIRADS; Bethesda; performance indicators; health management

Abstract

Background: Fragmented care pathways for thyroid nodular disease prolong time to decision and increase costs. “One-stop” clinics (OSCs) integrate clinical evaluation, ultrasound, ultrasound-guided fine-needle aspiration (FNA) and, when appropriate, rapid on-site evaluation (ROSE)/telecytology in a single visit.

Objective: To map organizational models of OSCs, define key performance indicators (KPIs), and summarize outcomes (time, visits, adequacy, repeat FNA, costs, patient satisfaction, safety).

Methods: Scoping review following PRISMA-ScR and JBI guidance. MEDLINE, Scopus, and Web of Science were searched (2000–August 2025). We included studies that operationalized OSCs and/or reported KPIs/outcomes. Data extraction covered organizational features, protocols (ACR/EU-TIRADS, Bethesda), flow metrics, FNA/ROSE adequacy, economics, satisfaction, and safety. Narrative synthesis was performed.

Results: Identified OSC models consistently shorten lead time to decision and reduce the number of visits. Sample adequacy is high—especially with ROSE/telecytology—thereby lowering repeat FNA rates. Patient satisfaction is high; the safety profile of FNA remains favourable. Economic analyses indicate that the cost-effectiveness of ROSE is context-dependent and greatest when baseline inadequacy is higher and/or ROSE costs are lower. A KPI set is proposed: lead time, proportion of “single-visit” completions, Bethesda I rate, ROSE utilization, repeat FNA ≤90 days, cost per episode, and satisfaction.

Conclusion: OSCs are an applicable, value-oriented model for thyroid diagnostics. Selective use of ROSE/telecytology and KPI-driven management enable efficient and safe implementation across diverse resource settings.

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