OP33 – Quality improvement using a clinical practice guideline with PTH in postsurgical hypoparathyroidism: a before and after study

     

    Valdez, Pedro1; Voogd, Ana1; Russier, Gerardo1; Begueri, Alejandro1; Guerra, Jorgelina2, Cavallo, Andrea2,  Negueruela, María del Carmen2; Saco, Pedro2.
    1 Head & Neck Surgery, Hospital Universitario Austral, Bueno Aires, Argentina
    2 Endocrinology, Hospital Universitario Austral, Buenos Aires, Argentina.

     

    Background: Post-thyroidectomy hypoparathyroidism is a frequent complication that may require the administration of intravenous calcium, a high-risk medication, to prevent seizures or cardiac arrhythmias. A clinical practice guideline using rapid PTH was evaluated on its effectiveness in reducing hospitalization time and improving patient safety by avoiding the unnecessary administration of intravenous calcium.

    Methods and Results:  From 2001 to 2015 a total of 668 patients were operated. The guideline was implemented in 2009, and 187 corresponded to the first period and 481 to the second period.
    The percentage of patients given calcium was similar (53 % pre and 52 % post), while the percentage who received it intravenously was 35 % in the first and 11 % during the second period. The risk of being hospitalized for more than 48 hours before the guide was 58 % and after the guide was 18 %. The application of the guide resulted in a protective factor of 0.149 times (IC 0.94-0.23) for the reduction of hospitalization time.Per-ward visits decreased from 4.81% to 2.29 % and readmissions were reduced from 0.53% to 0.42%.

    Conclusion:  The administration of intravenous calcium during hospitalization and the risk of prolonged hospitalization were reduced by three times, two objectives that have a significant impact on the quality of care and patient safety.  . In this experience, significant benefits were obtained in the safety and quality of patient care, significantly reducing hospitalization time and reducing the use of high-risk medication.

     

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