1208 Post-Tonsillectomy Re-Admissions – a Real Pain in the Mouth for Our Patients

Abstract

Abstract Aim Uncontrolled post-tonsillectomy pain is detrimental to patient safety and recovery, increasing the risk of morbidity from complications such as infection and secondary haemorrhage. A closed-loop audit of the adult and paediatric population evaluated operative and post-operative factors, and readmission and return to theatre rates against the National Prospective Tonsillectomy Audit (NPTA) and ENT UK Tonsillectomy Commissioning standards. Method Data from seventy-one and forty-three patients were collated over two treatment quarters in 2019/2020, including operative indication, surgical grade, dissection technique, estimated blood loss and local anaesthetic infiltration, in addition to post-operative analgesia instruction, length-of-stay, and discharge medications. Incidences of re-presentation within thirty days were reviewed, assessing the nature of complaint and indication for readmission. Inter-cycle intervention involved departmental education and dissemination of post-operative verbal/written patient education. Results Overall readmissions (15.5%), pain readmissions (1.4%/n = 1) and return to theatre cases (2.8%) exceeded national standards in cycle one (<15%, <1%, <1%), improving to standard in all domains bar pain readmission in cycle 2 (9.3%, 2.3%/n = 1, 0%). Length-of-stay was compliant throughout (0.2, 0.1 days). Documentation of post-operative analgesia instruction and simple and opiate discharge medication prescription in both adult and paediatric populations improved post-intervention (83% to 98%). Conclusions Scheduled, multimodal analgesia and discharge education that sets realistic expectations post-operatively are key in optimising the post-operative safety of our patients. In addition to verbal and written education, collaborative work with pharmacist colleagues to create and standardise a post-operative pain protocol and discharge analgesia pack will support and empower patients to enhance post-operative recovery and minimise avoidable hospital admission.