(A148) Streamlining Intraoperative Parathyroid Hormone Monitoring: A Quality Improvement Initiative

Introduction: Intraoperative parathyroid hormone (ioPTH) monitoring is critical during parathyroidectomy for evaluating surgical success. However, delays in laboratory processing can prolong operative times. This study evaluates the effectiveness of an intraoperative checklist in expediting ioPTH assay processes.

Methods: A multidisciplinary intraoperative checklist was developed to streamline communication and coordination between the circulating nurse, anesthesia team, operating surgeon, and laboratory. The checklist standardizes ioPTH collection and processing 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 value results were compared using the Student t test.

Results: Thirty patients were included in each group (n=60) involving 6 surgeons. Group A (with checklist) had a mean baseline PTH of 114.5 pg/mL and a post–15-minute PTH of 37.4 pg/mL. Group B (no checklist) had a mean baseline PTH of 203.8 pg/mL and a post–15-minute PTH of 51.9 pg/mL. Repeated measurements of ioPTH were not included. The mean time from sample collection to the post–15-minute ioPTH assay result was significantly reduced in Group A (20.1 min) compared to Group B (31.7 min; P< 0.05).

Conclusions: The implementation of a simple intraoperative checklist effectively reduces delays in ioPTH assay processing time, contributing to a more efficient surgical workflow. Additionally, it is cost-effective and requires minimal additional resources. This quality improvement intervention holds promise for broader adoption in parathyroid surgery to minimize delays and optimize patient care.