Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality...

Area of Science:

• Otolaryngology
• Surgical Quality Improvement
• Health Services Research

Background:

• Post-tonsillectomy hemorrhage (PTH) is a significant complication of tonsillectomy (TE).
• Wide variations in PTH rates exist among Swedish ENT centers, as identified by the National Tonsil Surgery Register in Sweden (NTSRS).
• A quality improvement project (QIP) was initiated in 2013 to address high PTH incidence.

Purpose of the Study:

• To describe and evaluate a multicenter quality improvement project (QIP) aimed at reducing post-tonsillectomy hemorrhage (PTH) rates.
• To assess the impact of the QIP on PTH incidence and related surgical practices.

Main Methods:

• Six participating ENT centers with above-average PTH rates implemented tailored improvement plans over 7 months.
• The primary outcome was the PTH rate, with process indicators like surgical technique also documented.
• QIP centers' data were compared to a control group of 15 centers, analyzing data from 12 months pre-QIP and 12 months post-QIP.

Main Results:

• The QIP centers significantly reduced their PTH rate from 12.7% to 7.1%.
• No significant change in PTH rate was observed in the control group.
• QIP centers showed increased use of cold techniques for dissection and hemostasis.

Conclusions:

• Quality improvement projects are effective in reducing post-tonsillectomy hemorrhage rates.
• National surgical registers are valuable tools for identifying areas needing improvement and evaluating the impact of interventions.
• These efforts can guide professional development and enhance patient outcomes in ENT surgery.