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Day case paediatric tonsillectomy: a quality improvement project

Mihiar Sami Atfeh1,2,3, James Richardson-May4, James Rainsbury4

  • 1University Hospitals Plymouth NHS Trust, Plymouth, UK. mihiaratfeh@nhs.net.

European Journal of Pediatrics
|July 31, 2018
PubMed

Insights

Paediatric day case tonsillectomy discharge rates improved safely by relaxing criteria, enhancing list management, and educating clinicians. This quality improvement project boosted profitability without increasing complications.

Area of Science:

  • Otolaryngology
  • Paediatric Surgery
  • Healthcare Management

Background:

  • Tonsillectomy is a frequent paediatric Ear, Nose, and Throat (ENT) procedure, with day case surgery offering significant cost-effectiveness.
  • Current guidelines for paediatric day case tonsillectomy patient selection lack universal consensus.
  • Optimizing day case pathways is crucial for efficient paediatric surgical care.

Purpose of the Study:

  • To enhance the effectiveness of the day case pathway for paediatric tonsillectomy.
  • To improve day case discharge rates and adherence to postoperative care guidelines.
  • To evaluate the long-term sustainability and financial impact of an optimized day case tonsillectomy pathway.

Main Methods:

  • A quality improvement project involving prospective and retrospective data collection over three cycles.
  • Implementation of a multifaceted intervention: evidence-based guideline revision, improved surgical list management, and clinician education.
  • Methodical relaxation of day case discharge criteria for paediatric tonsillectomy.

Main Results:

  • Significant improvement in day case discharge rates for paediatric tonsillectomy in both short-term and long-term follow-up.
  • No increase in postoperative complications was observed following the intervention.
  • Reduction in sleep study referrals and a notable increase in surgical list profitability.

Conclusions:

  • Evidence-based relaxation of day case criteria, coupled with enhanced list management and clinician education, successfully improved paediatric day case tonsillectomy practices.
  • The implemented interventions led to significant financial benefits without compromising patient safety or increasing postoperative complications.
  • This quality improvement initiative demonstrates a safe and effective model for optimizing paediatric day case tonsillectomy care.

Keywords:
AdenotonsillectomyDay casePaediatricQuality improvementTonsillectomy

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