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Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population
Vidya T Raman1, Kris R Jatana2, Charles A Elmaraghy2
1Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, United States.
Insights
New guidelines for pediatric adenotonsillectomy significantly reduced unplanned hospital admissions for children with obstructive sleep apnea (OSA). Adherence to these guidelines is crucial for further practice improvement.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Sleep Medicine
Background:
- Tonsillectomy is a common pediatric surgery, often for obstructive sleep apnea (OSA).
- Clinical assessment and parental history are frequently used despite polysomnography being the gold standard for OSA diagnosis.
- Nationwide Children's Hospital implemented guidelines to optimize hospital admission decisions for pediatric adenotonsillectomy.
Purpose of the Study:
- To decrease unanticipated hospital admissions following pediatric adenotonsillectomy.
- To identify areas for practice improvement in managing pediatric adenotonsillectomy patients.
Main Methods:
- Retrospective review of pediatric adenotonsillectomy cases (CPT codes 42820, 42830, 42825, 42826, 42821) from October 2009 to August 2012.
- Evaluation of unanticipated admissions against newly instituted hospital admission guidelines.
- Statistical analysis using Fisher's exact test and non-paired t-test to compare admission rates and demographic data before and after guideline implementation.
Main Results:
- Unanticipated admissions decreased from 88 to 43 (2.38% to 1.44%, p=0.008) after guideline implementation.
- The proportion of unanticipated admissions meeting guideline criteria for admission decreased from 42% to 30% post-guidelines.
- A significant reduction in unplanned admissions was observed.
Conclusions:
- Institution of pediatric adenotonsillectomy guidelines effectively reduced unanticipated hospital admissions.
- A persistent 30% rate of unanticipated admissions highlights non-compliance and the need for continuous practice improvement.
- Guidelines are valuable for optimizing care and resource allocation in pediatric adenotonsillectomy.
Introduction:
Tonsillectomy has become one of the most commonly performed surgical procedures in the pediatric-aged patient. Many of these children are diagnosed with obstructive sleep apnea (OSA). Although polysomnography is considered the gold standard, many practioners rely on the clinical examination and parental history. Nationwide Children's Hospital recently instituted pediatric adenotonsillectomy guidelines for hospital admission to help determine which patients should be done in main hospital OR vs. outpatient surgery facility. The main goal was to decrease unanticipated admissions. The secondary goal was to determine areas for practice improvement.
Methods:
Using databases for the hospital, operating room, and otolaryngology, all cases with CPT codes 42820, 42830, 42825, 42826, and 42821 were evaluated from October 2009 to August 2012 in the main operating room and 2 outpatient surgery centers. Data for each unanticipated admission were reviewed to determine whether the criteria were met according to the developed guidelines. Fisher's exact test was applied to the unplanned admission rate before and after the institution of the guidelines. Non-paired t-test and a Fisher's exact test were used for comparison of the demographic data between the two groups.
Results:
Following the institution of the pediatric adenotonsillectomy guidelines, the number of unanticipated admissions decreased from an absolute number of 88 to 43. This represents a decrease from 2.38% to 1.44% (p=0.008). Forty-two percent of the unanticipated admissions prior to establishing guidelines were in patients who would have met criteria for admission based on the guidelines. This decreased to 30% after establishing the guidelines.
Conclusion:
We found that the institution of pediatric adenotonsillectomy guidelines for patients undergoing adenotonsillectomy significantly decreased the rate of unanticipated admission. However, there was still a significant percentage (30%) of unanticipated admissions due to non-compliance with the guidelines demonstrating the need for ongoing practice improvement.
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