Endocrine Abstracts

Introduction: Our endocrine service introduced a nurse led parathyroid clinic to provide an efficient pathway for patients referred with hypercalcaemia.This benefits patients and clinical staff.

Materials/Methods: Patients referred with a raised calcium level are vetted by the endocrine consultants and directed to the nurse led clinic. The patients are seen within 6 weeks using a standard proforma and checklist. Relevant investigations to include renal function, bone profile, PTH, vitamin D, 24-hour urine calcium and spot urine calcium/creatinine ratio are arranged. Patient with Ca++>3 mmol/l are advised 2 weekly check of Ca++ level by GP. If Ca++ remains elevated, an appointment for administration of bisphosphonates is arranged. Standard letters are sent to the GP with clear instructions to cover a range of scenarios including vitamin D replacement, possible cardiac failure and higher calcium levels. Patients meeting criteria and willing for surgery are discussed with the medical team and parathyroid localisation studies are requested. Patients are directed to either the medical or surgical parathyroid clinic where they are seen with results of biochemical and radiological investigations where a treatment decision can be made at their first encounter with the surgeon or endocrinologist.

Results: Sixty-nine patients were seen by the nurse led clinic between April 2017 and March 2018. Twenty-four were willing and met surgical criteria and are either post-surgery or are awaiting an operation date. Thirty-five were not for surgery either because they did not meet criteria for surgery (23), had other significant illness (4) or refused surgery (8). Ten patients are still awaiting completion of radiological investigation.

Conclusion: We describe our experience of starting a nurse led parathyroid clinic which has improved the patient journey, including prompter assessments and reduced number of medical appointments.