Day case paediatric tonsillectomy: a quality improvement project

Abstract

Tonsillectomy is one of the commonest ENT paediatric procedures. Recovery is best achieved at home, and cost-effectiveness of the day case pathway is significant in tonsillectomy. This project scrutinised the local practice regarding the effectiveness of day case pathway in paediatric tonsillectomy in a large regional teaching hospital. The project aimed to improve the rates of day case tonsillectomy discharges, to increase compliance of postoperative care with guidelines, and to assess long-term sustainability of the new practice. The project looked prospectively at the pre-existing paediatric tonsillectomy day case practice (cycle 1) prior to implementing a multifaceted intervention. The intervention consisted of an evidence-based change to local day case tonsillectomy guidelines, improved lists' planning/management, and clinicians' education. Thereafter, the outcomes were measured in the short term (cycle 2-prospective data collection) and in the long term (cycle 3-retrospective data collection). The gathered data revealed an improvement in post-tonsillectomy day case discharge rates (both short and long term), without an increase in postoperative complications. Moreover, our intervention had effectively reduced sleep study requests and resulted in a significant increase in list profitability.Conclusion: The departmental practice in paediatric day case tonsillectomy was improved via evidence-based relaxation of day case criteria, improved list management, and clinicians' education. The interventions resulted also in a positive significant financial impact with no increase in postoperative complications. What is Known: • Tonsillectomy is a common paediatric ENT procedure, with significant applicability and cost-effectiveness of the day case pathway. • There is a lack of a clear general consensus on criteria for patients' suitability for day case tonsillectomy. What is New: • This quality improvement project carried out a methodical relaxation of day case criteria of day case tonsillectomy. • The new criteria along with enhanced list management and clinician education had safely improved the local post-tonsillectomy day case care.

Safety of day‐case paediatric tonsillectomy in England: an analysis of administrative data for the Getting It Right First Time programme

“…Our study is one of the largest to investigate outcomes after paediatric tonsillectomy in the UK [12]. Several single‐site UK‐based studies found no differences in outcomes for children who were discharged the same day as undergoing tonsillectomy compared with those who stayed overnight [13–15]. However, day‐case tonsillectomy is not suitable for all children and clear criteria for patient selection are needed.…”

“…Likewise, a 3-year audit of practice concluded that day-case tonsillectomies can be successful in selected children, but noted that a dedicated day-case team, good anaesthetic technique, adequate postoperative analgesia and on-site paediatric inpatient facilities are essential to optimise outcomes [14]. Finally, a quality improvement programme reported an increase in tonsillectomy day-case rates and decreased costs without an increase in postoperative complications at an English-teaching hospital [15].…”