What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

Hyperparathyroidism is a benign condition that manifests with excess of calcium levels in the blood due to the presence of a hyperactive parathyroid gland. When these levels raise above 2.7 mmol/L the patient can present symptoms such as difficult in concentration and “foggy brain”, chronic tiredness, increased frequency in urinating, constantly thirsty, bone aches and muscle aches, kidney stones. Excise the gland in the neck that is involved in the disease, can resolve most of these symptoms within 24 hours but waiting for surgery can create enormous frustration in the patients. This is mostly related to the fact that the symptoms are very generic to several pathologies and reaching a diagnosis can take years. Moreover the lately increase in waiting list due to recent contingency (COVID pandemic, doctors’ strike, increased lack of surgical beds and access to theatre) has worsened the length of frustration this category of patients is facing

What does your project aim to achieve?

Our project aim to provide safety surgical management of hypercalcaemia in the ambulatory care setting, which demonstrates waiting time reduction from 24 months to <2 months for eligible patients. We will perform a prospective study (therapeutic) divided in three phases aiming to prove:

1)    feasibility and safety of performing parathyroidectomy under local anesthesia,

2)    feasibility and safety of performing parathyroidectomy in the ambulatory setting (outpatient clinic).

How will the project be delivered?

Phase 1: anesthetic and surgical team will be trained in delivering safely local anesthesia for neck surgery. Patient feedbacks will be collected.

Phase 2: perform a minimum of 25 cases of parathyroidectomy under local anesthesia in a safely controlled environment (day surgery/main theatre) to establish/rectify inclusion/exclusion criteria of patients that can be safely selected for the ambulatory setting. Patient feedback, complications/outcomes will be than collected and discussed in the multidisciplinary team meeting (day surgery and ambulatory care nurses, anesthetic team and surgical team).

Phase 3: patient review and consent, followed by surgical interventions as per trial stipulations in the ambulatory care/outpatient clinic.

How is your project going to share learning?

Scientific publications, presentation to National and International Congresses and organization of courses will help us to train other colleagues to deliver same quality of care across the nation. In the framework of our professional organisation, the British Association of Thyroid and Endocrine Surgeons BAETS, we will host a webinar dedicated to dissemination of parathyroidectomy in the ambulatory care as well as the British association of Day surgery – BADS. We already host a similar event for the wider implementation of endocrine day surgery under this remit. Results of the three identified trials and investigations will be published in Q1 journals.