Improving Intraoperative Parathyroid Hormone Monitoring with a Multidisciplinary Checklist: A Quality Improvement Initiative.

Abstract

Intraoperative parathyroid hormone (ioPTH) monitoring is crucial during parathyroid surgery to ensure chemical cure. However, delays in processing can prolong operative times. This study evaluates the effectiveness of a checklist to expedite ioPTH assay processes. A multidisciplinary checklist was developed to standardize ioPTH collection and workflow. Thirty patients treated with use of the checklist were prospectively studied, while 30 patients treated without use of the checklist were retrospectively reviewed. Time intervals for post-15-minute ioPTH assay results were compared. Thirty age- and sex-matched patients were included in each group (n = 60) involving 5 surgeons. The intervention and control group had a mean baseline PTH of 140.9 and 130.3 pg/mL and a post-15-minute ioPTH of 69.6 and 52.0 pg/mL, respectively. The mean time from sample collection to the post-15-minute ioPTH assay result was significantly reduced in the intervention as compared to the control group (22.2 vs 33.3 minutes; P < .01). The proportional operative time spent awaiting ioPTH assay results was also reduced (24.4 vs 34.1%; P < .01). In subgroup analysis, a significant difference in the total operative time was found in adenomatous disease (68.0 vs 92.2 minutes, P < .05) but not four-gland hyperplasia (119.3 vs 142.3 minutes). The implementation of a simple intraoperative checklist effectively reduces the overall ioPTH assay processing time, creating a more efficient surgical workflow. It is low-cost and requires minimal additional resources. This quality improvement intervention holds promise for broader adoption in parathyroid surgery to reduce delays and optimize patient care.