Our Summary

This research paper discusses a project in Norway aimed at improving the outcomes of tonsil surgeries, specifically reducing the number of patients who have to be readmitted due to bleeding after the surgery. The study found that different hospitals in the country had quite different rates of these readmissions, with some as high as 25% and others at 0%, and an average of 8%.

To improve this, the researchers organized a project where they recorded videos of surgeons from the hospitals with the lowest readmission rates performing a specific type of tonsil surgery. These videos were then used to train the surgeons at the hospitals with high readmission rates.

After the training, the participants from each hospital went back to their respective institutions and prepared local plans to improve their results. They used a method called the Plan-Do-Study-Act model, which is a four-step model used for improving processes and products in various industries.

The results were encouraging. The hospitals that participated in the project reduced their readmission rates due to bleeding from 18% to 7%. Most of these hospitals also changed their tonsil surgery technique to the one shown in the training videos.

The researchers concluded that using videos as a teaching tool, along with new treatment plans and a focus on quality and improvement, can effectively improve the outcomes of tonsil surgeries. They also noted that these videos can show details that are hard to explain in written literature, and that quality registers (like the one that showed the initial differences in readmission rates) can be a valuable tool for identifying areas where improvement is needed and for evaluating the effects of changes in practice.

FAQs

  1. What was the purpose of the research project conducted in Norway?
  2. How did the researchers attempt to improve the outcomes of tonsil surgeries?
  3. What was the impact of the training videos and new treatment plans on the readmission rates for tonsil surgeries?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tonsillectomy is to follow all post-operative care instructions closely, including rest, hydration, and pain management. It is also important to avoid strenuous activities and follow a soft diet to allow for proper healing. If any signs of bleeding or infection occur, it is important to contact your healthcare provider immediately.

Suitable For

In general, tonsillectomy is recommended for patients who experience recurrent tonsillitis, sleep apnea, difficulty breathing or swallowing, or other complications related to the tonsils. Patients who have enlarged tonsils that cause significant discomfort or interfere with daily activities may also be recommended for tonsillectomy.

Specific criteria for recommending tonsillectomy may include:

  1. Recurrent tonsillitis: Patients who have multiple episodes of tonsillitis in a year may be recommended for tonsillectomy to prevent further infections.

  2. Enlarged tonsils: Patients with significantly enlarged tonsils that cause difficulty breathing, swallowing, or speaking may benefit from tonsillectomy.

  3. Sleep apnea: Tonsillectomy may be recommended for patients with obstructive sleep apnea caused by enlarged tonsils that block the airway during sleep.

  4. Tonsil stones: Patients who have recurrent tonsil stones, which are small, hard stones that form in the crevices of the tonsils, may be recommended for tonsillectomy to prevent further formation.

  5. Tonsil cancer: In rare cases, patients with tonsil cancer may require tonsillectomy as part of their treatment plan.

It is important for patients to discuss their symptoms and medical history with a healthcare provider to determine if tonsillectomy is the best treatment option for their specific condition.

Timeline

Before tonsillectomy:

  1. Patient experiences recurrent tonsillitis, enlarged tonsils, difficulty swallowing, or other symptoms that indicate the need for tonsil removal.
  2. Patient consults with an ear, nose, and throat (ENT) specialist who recommends tonsillectomy as a treatment option.
  3. Patient undergoes pre-operative assessments, which may include blood tests, imaging studies, and discussions about anesthesia and post-operative care.

After tonsillectomy:

  1. Patient undergoes the surgical procedure to remove the tonsils, which is typically performed under general anesthesia.
  2. Patient may experience pain, discomfort, and difficulty swallowing in the days following the surgery.
  3. Patient is discharged from the hospital or surgical center and instructed on post-operative care, which may include pain management, dietary restrictions, and activity limitations.
  4. Patient follows up with their healthcare provider for post-operative appointments to monitor healing and address any concerns or complications.
  5. Patient gradually recovers from the surgery, with symptoms improving over time as the surgical site heals.
  6. Patient experiences long-term benefits of tonsillectomy, such as reduced frequency of throat infections or improved breathing and sleep quality.

What to Ask Your Doctor

Some questions a patient should ask their doctor about tonsillectomy include:

  1. What are the potential risks and complications associated with tonsil surgery, such as bleeding after the procedure?
  2. How experienced is the surgeon in performing tonsillectomies, and what is their rate of post-operative complications?
  3. What techniques will be used during the surgery, and how do they compare to the methods shown in the training videos mentioned in the research paper?
  4. What measures will be taken to prevent post-operative bleeding, and how will it be managed if it does occur?
  5. How will my pain be managed after the surgery, and what is the expected recovery time?
  6. Will there be a follow-up plan in place to monitor my recovery and address any concerns or complications that may arise?
  7. Are there any specific pre-operative or post-operative instructions I should follow to ensure the best possible outcome?
  8. How can I be involved in my own care and advocate for my health during the surgical process?
  9. Are there any alternative treatments or options available for my condition that I should consider before proceeding with a tonsillectomy?
  10. Are there any specific questions or concerns I should bring up with the surgical team based on the information provided in this research paper?

Reference

Authors: Bugten V, Wennberg S, Amundsen MF, Blindheimsvik MAB. Journal: BMJ Open Qual. 2022 Nov;11(4):e001887. doi: 10.1136/bmjoq-2022-001887. PMID: 36410782