Transcript Audit of Day Case Tonsillectomy Aintree University

Audit of Day Case Tonsillectomy
Aintree University Hospital, Liverpool
M Baghat1, S Knott2, G Bessant2, EZ Osman2.
1:Faculty of Medicine, Alexandria University, Egypt 2: Department of ENT and Head and Neck Surgery, University Hospital Aintree,
The aim of this audit is to assess the Day Case Surgery tonsillectomy procedures provided at
University Hospital Aintree (UHA) in line with the National Prospective Tonsillectomy Audit by the
Royal College of Surgeons, England 2007.
Background
RESULTS
Day surgery is the admission of selected patients to hospital for a
planned surgical procedure, returning home on the same day1.
Table showing readmission and complication rates following day-case tonsillectomies at
Aintree Hospital main site and elective care day surgery unit.
The 2000 ‘NHS plan’ set a target of 75% of all surgical activity to
be performed as such day case procedures2.
In 2006 we introduced a new service for adult ENT patients in
Liverpool, with the intent of performing tonsillectomies as day
case if possible.
At present, all uncomplicated tonsillectomies are performed at
Aintree with the intention of being day case procedures. Some of
these cases are performed within the dedicated day case surgical
unit, while the majority are performed within the main hospital
site.
Methods
Period under investigation: 01/01/2010 - 31/12/2010 (12 months).
The details of all patients who underwent tonsillectomy in 2010
were obtained from the audit and clinical coding departments.
UHA
DSU
National Audit Levels
No. of patients
145
28
33.921
Gender (F:M)
2.6:1
3:1
2.2:1
Complications rate
14.5% (n 21)
14.3%(n 4)
N/A
Re-admission rate
11% (n16)
0.0%
3.9%
Primary haemorrhage
2% (n 3)
0.0%
0.6%
Secondary haemorrhage
4% (n6)
0.0%
3.0%
Return to theatre
2% (n 3)
0.0%
0.9%
Blood transfusion
0.0%
0.0%
0.2%
Effective day case rate
59%
100%
12%
UHA: Aintree main hospital site. DSU: Aintree Day Surgery Unit.
Percentage of patients admitted for day case tonsilectomy at
Aintree main site who stayed at least one night.
Graph to show age distribution of patients
undergoing tonsilectomy at UHA
41%
217 patients were identified within the audit time frame in Aintree
hospital.
59%
Admission
Home same day
We reviewed the case notes of all patients who had complications
Data was analysed using Microsoft Excel spreadsheets.
60
50
Patients’ electronic records were reviewed on the hospital Medway
Sigma information system.
173 patients who underwent only bilateral tonsillectomy and not
tonsillectomy as a part of another operation were included.
3
40
Total no.
30
patients
100% of tonsillectomy patients
undergoing surgery at the elective care
day case unit returned home the same
day as their operation.
f
20
10
0
<20
Female Male
20-29
30-39
>40
Age (years)
Discussion
Day case tonsillectomies performed at Aintree are feasible and highly successful; 100%
of patients with tonsillectomy performed at the day case surgical unit returned home on
the same day with nil readmissions. Almost two-thirds of those procedures performed
on the main hospital site returned home same day.
References
1. Gandhimani, P. Jackson, I. UK Guidelines
for day surgery. Surgery 2006. 24;10;346-349
2. Department of health. The NHS plan: a
plan for investment, a plan for reform. London,
DH, 2000.
3. National prospectus tonsillectomy, Audit by
the Royal College of Surgeons, England
2007.
We provide adult service only and this explain our high postoperative bleeding rate. In
the national audit adults had higher bleeding rates 4.9% and return to theatre 1.2%
Our readmission rate is higher than the results of the national audit and this reflect our
policy of re-admitting patients with postoperative complications
Recommendations
Improvement of list planning at the main hospital site with tonsillectomies on the
morning lists if possible.
Modification of our anaesthetic protocol at the main hospital.
Maximum pain control should be prescribed on discharge
British Association of Otorhinolaryngology- Head and Neck Surgery.
ENT UK.
FOUNDATION ENT AND HEAD AND NECK SURGERY
CONFERENCE. March 2011.
Royal College of Surgeons of England, London.
Prior to discharge, the surgeon should reinforce the written information provided
regarding postoperative care and the importance of eating and drinking .