Streamlining Health Care Access for Patients With Primary Hyperparathyroidism: A Quality Improvement Pilot Program

Patients with hyperparathyroidism (HPT) are typically referred to endocrinology for initial evaluation, often with prolonged wait times. We introduced a pilot program that triaged primary HPT (pHPT) patients directly into endocrine surgery clinic, bypassing endocrinology, to evaluate the difference in time between referral and appointment for endocrine surgery versus endocrinology and determine if patients received expedited care through this process.

From November 2022 to March 2024, HPT patients referred to endocrinology were screened for pHPT (Ca ≥10.7 and parathyroid hormone ≥65). Eligible patients were scheduled with endocrine surgery. Patients who did not meet the criteria or refused surgical evaluation were scheduled with endocrinology. The primary outcome was to evaluate the difference in time between initial referral and appointment for endocrine surgery versus endocrinology. Patient demographics, laboratory values, and surgical treatment were also collected. Descriptive analysis was performed in SPSS with categorical variables evaluated with chi-square tests and continuous variables evaluated with independent sample t-test or Mann-Whitney U test.

Our pilot program referred 65 of 134 (48.5%) patients to endocrine surgery, whereas 69 of 134 (51.5%) were referred to endocrinology. Of these, 61 of 65 (93.8%) patients were seen by endocrine surgery, and 60 of 69 (87.0%) patients were seen by endocrinology. The mean time between referral and surgical appointment was 28 d (standard deviation 18), which was significantly less than the mean time interval of 118 d (standard deviation 73) for endocrine appointment (P < 0.001). Endocrine surgery patients had higher calcium levels than endocrinology patients (mean 11.4 versus 10.4, P < 0.001), but parathyroid hormone levels were not different (mean 135.6 versus 128.2, P = 0.43). Among endocrine surgery patients, 48 of 61 (78.7%) underwent parathyroid surgery compared to 10 of 60 (16.7%) endocrinology patients (P < 0.001).

For pHPT patients, initial referral to endocrine surgery significantly decreased time to evaluation, streamlined access to surgery, and decreased burden of care for endocrinology.