Improving the Management of Post-Operative Hypocalcaemia in Thyroid Surgery

Area of Science:

• Endocrinology
• Surgical Quality Improvement
• Patient Safety

Background:

• Hypocalcaemia is a common and serious complication after total thyroidectomy due to parathyroid gland devascularisation.
• Existing postoperative guidelines for managing hypocalcaemia risk require optimization in clinical practice.

Purpose of the Study:

• To improve adherence to postoperative guidelines for recognizing and managing hypocalcaemia after total thyroidectomy.
• To enhance the monitoring and management of patients at risk for hypocalcaemia.

Main Methods:

• A quality improvement project in an ENT department over one year.
• Included a baseline audit, introduction of an intraoperative parathyroid hormone (PTH) pathway, and guideline amendments.
• Focused on clinician education, communication, patient handover, and optimizing PTH/calcium testing and prophylactic calcium prescribing.

Main Results:

• Significant improvement in hypocalcaemia monitoring for intermediate-risk patients (22.2% to 83.3%).
• Increased prophylactic calcium prescribing (7.5% to 43.5%).
• Modest improvement in four-hour PTH measurement (42.5% to 52.2%).

Conclusions:

• Optimizing postoperative care through this quality improvement initiative enhanced patient safety.
• Improvements in care potentially reduced inpatient stay duration and overall costs.