{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T10:13:48Z","timestamp":1792059228524,"version":"4.4.0"},"reference-count":13,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T00:00:00Z","timestamp":1731369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Epidermal cysts are common benign lesions encountered in primary care, especially in minor surgery clinics. The management of large epidermal cysts (&gt;5 cm in diameter) poses significant challenges, including surgical intervention requirements, potential for complications, and impacts on patient care and clinic workflow. The prevalence of these cysts underlines the need for optimised management strategies that are essential for enhancing patient outcomes and clinic efficiency. This quality improvement initiative sought to better manage large epidermal cysts in primary care settings. Patients and methods: The initiative utilised the Plan-Do-Study-Act (PDSA) cycle over three distinct phases, with an emphasis on improving surgical techniques and postoperative care, optimising clinic workflow, and enhancing patient education and involvement. Over the course of this eighteen-month study, 100 patients who required surgical excision of large epidermal cysts were included. The interventions focused on standardising surgical protocols, implementing a new scheduling system, and developing comprehensive educational materials for patients. Results: The programme contributed to major efficiency gains for surgeries: the average operative time was reduced from 45 min to 30. The postoperative complication rate decreased dramatically while patient and clinician satisfaction went up, as did clinic throughput. With patient education enhancements, follow-up adherence rose to 92% while the postoperative complication rate declined from 18% to 9% with the overall approach to patient engagement. Conclusions: The successful application of the PDSA cycles in this work demonstrates that quality improvement methodologies have a potential role in optimising management for large epidermal cysts in primary care settings. Developed interventions can therefore be put into routine care that will indeed improve patient outcome, clinician experience, and operational efficiency in minor surgery clinics.<\/jats:p>","DOI":"10.3390\/clinpract14060190","type":"journal-article","created":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T09:36:51Z","timestamp":1731404211000},"page":"2433-2444","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Enhancing Outcomes and Efficiency in Large Epidermal Cyst Management: Quality Improvement Approach in Primary Care"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6914-7401","authenticated-orcid":false,"given":"Waseem","family":"Jerjes","sequence":"first","affiliation":[{"name":"Research and Development Unit, Hammersmith and Fulham Primary Care Network, London W6 7HY, UK"},{"name":"Faculty of Medicine, Imperial College London, London SW7 5NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pratik","family":"Ramkumar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London, London SW7 5NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuf","family":"Yaqub","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Imperial College London, London SW7 5NH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,12]]},"reference":[{"key":"ref_1","unstructured":"Zito, P.M., and Scharf, R. (2023, August 08). Epidermoid Cyst, StatPearls [Internet], Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499974\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"136","DOI":"10.12701\/yujm.2019.00164","article-title":"Factors affecting complications after treatment of epidermal cyst","volume":"36","author":"Choi","year":"2019","journal-title":"Yeungnam Univ. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.wneu.2018.08.197","article-title":"Dermoid and Epidermoid Cysts of Scalp: Case Series of 234 Consecutive Patients","volume":"120","author":"Prior","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Knudsen, S.V., Laursen, H.V.B., Johnsen, S.P., Bartels, P.D., Ehlers, L.H., and Mainz, J. (2019). Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-019-4482-6"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"n1010","DOI":"10.1136\/bmj.n1010","article-title":"Different approaches to making and testing change in healthcare","volume":"374","author":"Ogrinc","year":"2021","journal-title":"BMJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1159\/000487794","article-title":"Incidental Squamous Cell Carcinoma in an Epidermal Inclusion Cyst: A Case Report and Review of the Literature","volume":"10","author":"Frank","year":"2018","journal-title":"Case Rep. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"\u00c5hlin, P., Almstr\u00f6m, P., and W\u00e4nstr\u00f6m, C. (2023). Solutions for improved hospital-wide patient flows\u2014A qualitative interview study of leading healthcare providers. BMC Health Serv. 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Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zhai, K., Yousef, M.S., Mohammed, S., Al-Dewik, N.I., and Qoronfleh, M.W. (2023). Optimizing Clinical Workflow Using Precision Medicine and Advanced Data Analytics. Processes, 11.","DOI":"10.3390\/pr11030939"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"H\u00fcgle, T., and Grek, V. (2023). Digital transformation of an academic hospital department: A case study on strategic planning using the balanced scorecard. PLOS Digit. Health, 2.","DOI":"10.1371\/journal.pdig.0000385"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Navarro, M.D. (2020). Patients\u2019 empowerment and the role of patients\u2019 education. Med. Res. Arch., 8.","DOI":"10.18103\/mra.v8i12.2306"}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/14\/6\/190\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:30:29Z","timestamp":1760113829000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/14\/6\/190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,12]]},"references-count":13,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["clinpract14060190"],"URL":"https:\/\/doi.org\/10.3390\/clinpract14060190","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,12]]}}}