Improving the Pediatric Floor Discharge Process Following Tonsillectomy

Christina J. Yang, Danielle Bottalico, Kaitlyn Philips, Alison DeSilva, Victoria Cheung, Joanna Joels, Carlos Cruz, Patricia A. Hametz

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives/Hypothesis: Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. Study Design: Prospective observational (quality improvement). Methods: A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was “timely discharges,” defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven-day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record-based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. Results: Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7-day readmission rates were unchanged. Conclusions: By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. Level of Evidence: III Laryngoscope, 2021.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2021

Keywords

  • ambulatory surgical procedures
  • care coordination
  • pediatric hospital medicine
  • pediatric hospitals
  • Quality improvement
  • quality of healthcare
  • surgical comanagement
  • tonsillectomy

ASJC Scopus subject areas

  • Otorhinolaryngology

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