Unexpected Benefits in Single Institution Experience With Successful Implementation of a Standardized Perioperative Protocol in Pediatric Thyroidectomy.

• Type of Material: Article
• Authors: Kristina Cossen, Emory University; Matthew Santore, Emory University; Kara Prickett, Emory University; Steven Goudy, Emory University; Kurt Heiss, Emory University; Kanika Shanker, Goryeb Children's Hospital, Atlantic Health System; Adina Alazraki, Emory University; Briana Patterson, Emory University
• Language: English
• Date: 2022
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/pq9.0000000000000568
• Title of Journal or Parent Work: Pediatr Qual Saf
• Volume: 7
• Issue: 3
• Start Page: e568
• End Page: e568
• Keywords: Pediatric Thyroidectomy
• Research Categories: Health Sciences, Radiology

Abstract

INTRODUCTION: To illustrate how quality improvement can produce unexpected positive outcomes. METHODS: We compared a retrospective review of perioperative management and outcomes of baseline 122 pediatric total thyroidectomies to 121 subsequent total thyroidectomies managed by an Electronic Medical Record protocol in a large, free-standing children's healthcare system. Process measures included serum calcium measurement 6-12 hours postoperatively; parathyroid hormone measurement 6 hours postoperatively; preoperative iodine for Graves disease, and postoperative prophylactic calcium carbonate administration. In addition, we completed 4 Plan-Do-Study-Act (PDSA) cycles, focusing on implementation, refinement, usage, education, and postoperative calcitriol administration. The primary outcome included transient hypocalcemia during admission. RESULTS: All perioperative process measures improved over PDSA cycles. Measurement of postoperative serum calcium increased from 42% at baseline to 100%. Measurement of postoperative PTH increased from 11% to 97%. Preoperative iodine administration for Graves disease surgeries improved from 72% to 94%. Postoperative calcium carbonate administration increased from 36% to 100%. There was a trend toward lower rates of severe hypocalcemia during admission over the subsequent PDSA cycles starting at 11.6% and improving to 3.4%. With the regular review of outcomes, surgical volume consolidated among high-volume providers, associated with a decrease in a permanent hypoparathyroid rate of 20.5% at baseline to 10% by the end of monitoring. CONCLUSIONS: In standardizing care at 1 large pediatric institution, implementing a focused quality improvement project involving the perioperative management of transient hypocalcemia in total thyroidectomy pediatric patients resulted in additional, unanticipated improvements in patient care.