(A101) A Systematic Review and Typology of Quality Improvement Interventions in Tonsillectomy Patient Care

Introduction: Over 500,000 tonsillectomies are performed annually in the US. Guidelines for quality improvement (QI) in tonsillectomy have recently been released; our review examines documented QI interventions in tonsillectomy.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched for articles using PubMed, Scopus, and the Cochrane databases in November 2024. Two reviewers (SN and SJ) screened articles for inclusion and extracted results. Studies were included if they measured outcomes of interventions described as a quality improvement project (QIP) or used a QI tool such as Lean, A3, clinical practice guidelines (CPGs), plan-do-check-act (PDCA) or plan-do-study-act (PDSA), or care pathways. Non-English articles were excluded. 1,295 articles were screened and 31 met inclusion criteria.

Results: Two reviewers compiled a description of each QI intervention and extracted results. Outcomes most commonly focused on readmissions (N=11), post-operative opioid use (N=8), and post-operative bleeding (N=8). QI tools used were CPGs (N=11), PDSA/PDCA (N=9), Care Pathways (N=3), and Lean or A3 (N=2). A minority of studies (N=6) described the intervention as a QIP without mentioning specific QI tools. The most common tools for reducing readmission were PDSA/PDCA (N=5) and CPG (N=5) and for reducing opioid use was PDSA/PDCA (N=4). Most QI interventions reported significant improvement in at least one outcome metric measured (93%, N=28).

Conclusions: Our review suggests applying QI tools can improve outcomes in tonsillectomy patients. Comparing interventions is hindered by heterogeneity in outcome reporting timelines as well as in duration of intervention implementation. Future work should create standardized evaluation metrics of QI programs in otolaryngology.