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Improving the Pediatric Floor Discharge Process Following Tonsillectomy

Christina J Yang1,2, Danielle Bottalico1, Kaitlyn Philips2,3

  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, U.S.A.

The Laryngoscope
|July 8, 2021
PubMed

Insights

Improving timely pediatric tonsillectomy discharges is crucial. Quality improvement initiatives significantly increased the percentage of patients discharged before 11 AM on postoperative day 1.

Area of Science:

  • Pediatric Surgery
  • Quality Improvement Science
  • Healthcare Management

Background:

  • Tonsillectomy is a common pediatric procedure with significant hospital resource utilization.
  • In 2017, only 10.4% of pediatric tonsillectomy patients at our institution were discharged before 11 AM on postoperative day 1 (POD1).

Purpose of the Study:

  • To increase the percentage of pediatric tonsillectomy patients discharged before 11 AM on POD1 to at least 50% within one year.
  • To optimize postoperative care pathways and reduce length of stay.

Main Methods:

  • A prospective observational quality improvement study was conducted.
  • Interventions included an electronic health record handoff prompt, discharge checklist, automated instructions, and early morning rounds.
  • Data were analyzed using control charts to monitor timely discharges (before 11 AM and 1 PM POD1) and length of stay.

Main Results:

  • Within 12 months, discharges before 11 AM on POD1 increased to 44.9%, and before 1 PM increased to 83.8%.
  • These improvements were sustained for at least six months.
  • Mean length of stay decreased, while 7-day readmission rates remained unchanged.

Conclusions:

  • Understanding factors influencing timely discharges enabled targeted interventions.
  • The implemented quality improvement strategies successfully increased early postoperative day 1 discharges for pediatric tonsillectomy patients.
  • This approach demonstrates a viable method for enhancing efficiency in pediatric surgical care.
Abstract

Keywords:
Quality improvementambulatory surgical procedurescare coordinationpediatric hospital medicinepediatric hospitalsquality of healthcaresurgical comanagementtonsillectomy

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