Reducing post-tonsillectomy haemorrhage: a multicentre quality improvement programme incorporating video-based cold...

Area of Science:

• Otolaryngology
• Surgical Quality Improvement
• Medical Education

Background:

• Significant variations in post-tonsillectomy hemorrhage (PTH) readmission rates exist across Norwegian hospitals (0%-25%).
• A quality improvement project was initiated to address these disparities, involving hospitals with high and low readmission rates.

Purpose of the Study:

• To reduce the readmission rate due to post-tonsillectomy hemorrhage (rrPTH).
• To identify surgical techniques and educational strategies that improve outcomes after tonsillectomy.

Main Methods:

• A quality improvement project involving 11 hospitals, utilizing videos of cold dissection tonsillectomy from high-performing surgeons.
• Implementation of a 2-day workshop and the Plan-Do-Study-Act model for local improvement plans.
• Monitoring patient-reported rrPTH using the Norwegian Tonsil Surgery Register (NTSR).

Main Results:

• Participating hospitals reduced their rrPTH from 18% to 7% between 2017/2018 and 2020.
• Six out of seven high-rate hospitals significantly increased their use of cold dissection techniques.

Conclusions:

• Learning and implementing cold dissection tonsillectomy can decrease post-tonsillectomy bleeding complications.
• A combination of video-based surgical training, structured improvement plans, and quality registers can effectively enhance surgical results and patient safety.