How we do it: Implementing change – a multi‐centre audit of an evidence‐based protocol on post‐thyroidectomy calcium maintenance

Abstract

Keypoints • Our previous retrospective audit (Clinical Otolaryngology, December 2004) identified considerable variation in post‐thyroidectomy calcium assessment. This led to a well‐structured protocol. • The protocol was introduced into two trusts. The results were prospectively collated for 64 thyroid procedures over a period of 6 months. • All patients that warranted it were tested on day 1, and 71% were tested on day 2 – highlighting a more structured approach, and avoiding unnecessary vene‐ puncture in all thyroid lobectomy patients. • Such protocols have been proven to be an important tool in the effort to improve the quality and lower the cost of care. • Resistance to change, established practise and lack of data collection resources prevented this protocol from becoming established in more regional trusts.

The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies

“…23,33 When hypocalcaemia does occur, the decision to prescribe calcium alone or with vitamin D has led to algorithms being published. 1,34 Our patients with a corrected serum calcium of < 2.0 mmol/l received calcium with additional vitamin D prescribed for 4 weeks initially if the corrected serum calcium was < 1.8 mmol/l. Thirteen patients were discharged on calcium alone and 20 received calcium and vitamin D supplements with medication continued long-term in the 9 patients with permanent hypocalcaemia.…”

Early Prediction of Oral Calcium and Vitamin D Requirements in Post‐thyroidectomy Hypocalcaemia

“…Among the published selective supplementation approaches, Tunbridge Wells (Hospital) protocol, 10 based on laboratory assessments (calcium and phosphate levels), revealed inconsistent management of post-thyroidectomy patients, and attempts to implement this protocol in other institutions met with limited success. 11 On the other hand, Wiseman et al, 12 Cayo et al, 13 and Raffaelli et al 14 developed their post-thyroidectomy hypocalcemia management protocols based on allocating the patients into different groups, based on their actual postoperative PTH levels, and supplementing each group with different calcium and vitamin D doses. Wiseman et al 12 developed an algorithm based on different 3-and 1-hour post-thyroidectomy PTH cutoffs.…”

Post-Thyroidectomy Hypocalcemia: Impact on Length of Stay

“…A standardized approach to management would be expected to improve patient care, facilitate the process of obtaining informed consent, and lead to a reduction in the length of hospital stay. 1,13 Until June 2009, there was no formal guidance on the management of postoperative hypocalcemia at our institution. To remedy this, we conducted a study to identify the incidence of hypocalcemia after total and completion thyroid surgery, to determine the impact of hypocalcemia on length of stay (LOS), to review the existing management of postoperative hypocalcemia, and to review these data after the implementation of a standardized postoperative management guideline.…”