The Improved Quality Process after Implementation of
the Hemithyroidectomy Care Map
Weerachai Tantinikorn MD*, Kanlaya Jitta BNS**,
Supreeya Petrak BNS**, Paraya Assanasen MD**
Affiliation :
* Ear, Nose and Throat Center, Bumrungrad International Hospital, Bangkok, Thailand
** Department of Oto-Rhino-Laryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To report the improved quality process in service care of the patients undergoing hemithyroidectomy and the
results of the care map implementation.
Material and Method: Descriptive analysis and retrospective chart reviews were performed in the patients who underwent
hemithyroidectomy in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital before and after the
care map implementation between January 2004 and December 2006.
Results : Hemithyroidectomy care map has been created with good cooperation of all members of our department in January
2005. Two hundred seventy nine patients, including 246 females (88%) and 33 males (12%) participated in this study. The
care map was used in all patients. Hospital stay was reduced from five to eight days to less than four days in 93% of the
patients. The estimated expenses of 97% of the patients differed from the true expense at less than 20%. Complications were
minimized to the acceptable level by close supervision of the attending staffs. Incidence of vocal cord paralysis was reduced
from 8.7% before the care map implementation to 2.4% and 2.3% in the first and second years. Hematoma was observed
in three cases within 24 hours postoperatively and could not be prevented by drain insertion. Only minimal content was
found in the drain after 48 hours.
Conclusion : The improved quality process in hemithyroidectomy care received good cooperation from all members in our
department. Effective resource utilization was achieved with maximal patients’ benefit and satisfaction. Close supervision
by attending staffs, meticulous surgical techniques, and adequate bleeding control are the keys of effective clinical care.
Hospital stay is possibly reduced to one to two days by good pre-anesthetic care before admission and by avoiding or using
drain only in selected cases for six to 48 hours.
Keywords : Hemithyroidectomy, Care map, Complication, Drain, Hospital stay, Expenses
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