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Decreasing Seven-Day Revisits After Pediatric Tonsillectomy: A Multidisciplinary and Comprehensive Unit-Based Safety

Chris Deskins¹, Helene Dabbous², Samantha Smith¹

¹Anesthesiology, West Virginia University, Morgantown, USA.

|December 29, 2025

Summary

A new care bundle reduced pediatric tonsillectomy revisits by optimizing hydration and pain management. This involved standardized intraoperative care, clear discharge instructions, and improved communication, leading to a significant decrease in readmissions.

Keywords:

comprehensive unit-based safety program pain optimization perioperative dehydration prevention post-discharge revisit tonsillectomy

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Area of Science:

Pediatric surgery
Quality improvement in healthcare
Patient safety

Background:

Pediatric tonsillectomy is a common procedure with high post-operative revisit rates.
Identified areas for improvement include hydration, pain management, and discharge instructions.
Institutional revisit rates exceeded national benchmarks in early 2025.

Purpose of the Study:

To reduce the seven-day post-tonsillectomy revisit rate by ≥1% in patients aged 0-21.
To implement a perioperative dehydration-prevention and pain-optimization bundle.
To utilize a Comprehensive Unit-based Safety Program (CUSP) framework for intervention.

Main Methods:

A multidisciplinary team at WVU Medicine Golisano Children's Hospital conducted three Plan-Do-Study-Act (PDSA) cycles.
Interventions included standardized intraoperative fluids (crystalloid bolus), analgesia (acetaminophen, dexamethasone), and post-operative care (ibuprofen, hydration checklist, medication calendar).
Monthly reviews of revisit rates and process measures were performed.

Main Results:

Pain and dehydration were identified as primary factors for revisits.
Interventions led to standardized intraoperative fluids and analgesia.
Improved discharge clarity and aligned communication workflows were observed.

Conclusions:

A perioperative bundle focusing on hydration, multimodal analgesia, and discharge instructions demonstrated feasibility in reducing short-term revisits.
The study observed a reduction in revisit rates from 3.75% to 2.16%.
Longitudinal monitoring is necessary to assess the durability and sustainability of these improvements.