Enhancing adherence to tonsillectomy guidelines: a quality improvement audit in a resource-limited setting

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Healthcare Quality Improvement

Background:

• Recurrent tonsillitis is a global pediatric health issue requiring tonsillectomy.
• The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) provides guidelines for tonsillectomy.
• Adherence to AAO-HNS guidelines is suboptimal in resource-limited settings.

Purpose of the Study:

• To assess adherence to AAO-HNS tonsillectomy guidelines in Pakistan.
• To evaluate the impact of an educational intervention on guideline compliance.
• To examine the effect of the intervention on patient outcomes.

Main Methods:

• A two-cycle clinical audit involving 120 pediatric patients.
• Baseline adherence assessment before an educational intervention.
• Post-intervention audit to measure changes in adherence and outcomes.

Main Results:

• Initial adherence to key guidelines like perioperative counseling and dexamethasone use was low.
• Educational intervention significantly increased adherence to dexamethasone use (60% to 100%) and counseling (20% to 48.3%).
• Gaps persisted in diagnosing obstructive sleep apnea and antibiotic practices due to cost and resistance.

Conclusions:

• Targeted educational interventions can improve short-term adherence to tonsillectomy guidelines.
• Sustained adherence requires long-term monitoring and follow-up.
• Future strategies must address cost-effective diagnostics and entrenched clinical practices.