Introduction

This topic is intended to help anyone who is interested in quality improvement surrounding Thyroid Disorders.

Available toolkit projects are listed below. Many of the approaches described are evidence based - some are not. These approaches have not been approved by APSA.

Projects

Mott Children’s Hospital

Mott developed the multispecialty pediatric endocrine surgery (MPES) protocols to standardize the care provided by physicians, nurses and house staff while caring for children with endocrine surgery problems.

Protocols

• thyroid nodule evaluation
• thyroid and parathyroid postoperative care
• thyroid cancer follow-up

Stakeholders: pediatric endocrinology, pediatric anesthesiology, pediatric surgery, MPES nurses

Challenges and solutions: One surgeon and two endocrinologist developed and participate in the MPES clinic. The surgeon performs all of the operations. However, all of our surgeons and all of our endocrinologists care for these patients while in the hospital following their surgery. This lead to variation in practice while dealing with postoperative issues. These protocols standardized and publicized our care for the MPES patients.

Submitted by Steven Bruch

Nemours / Dupont

They created a clincial practice guideline for the preoperative work up and postoperative management of hypocalcemia, EPIC order sets with labs and medications embedded and a preoperative checklist for patients with thyroid neoplasms to confirm the correct surgery is being done and clarify areas of lymph node involvement.

Protocol

• thyroid clinical practice guideline
• EPIC thyroid checklist

Submitted by Loren Berman