Title : Telenursing: Enhancing post-discharge care through structured follow-up for post tonsillectomy patient
Abstract:
Tonsillectomy remains one of the most frequently performed surgical procedures in both adult and pediatric otolaryngology, with a well recognized spectrum of postoperative complications. These may include sore throat, nausea and vomiting, dehydration, otalgia, Eustachian tube dysfunction, delayed feeding, velopharyngeal incompetence, pulmonary edema, and postoperative bleeding, which in rare cases can be fatal. Among these complications, Post Tonsillectomy Hemorrhage (PTH) is the most clinically significant due to its unpredictable nature and potential for life threatening outcomes. PTH is classified into primary hemorrhage, occurring within the first 24 hours, and secondary hemorrhage, occurring after 24 hours. Primary bleeding is often linked to surgical technique, inadequate vessel contraction, or coagulation issues, whereas secondary bleeding is associated with factors such as age, sex, NSAID use, poor oral intake, and seasonal variations. PTH frequently necessitates emergency readmission, operative intervention, and may result in shock, airway compromise, or the need for blood transfusion. Effective post discharge care is therefore essential, as many patients and caregivers struggle to manage symptoms at home, leading to anxiety, delayed recognition of complications, and avoidable emergency visits. Structured follow up particularly through remote or telephone based interventions offers a promising strategy to enhance continuity of care and reduce preventable harm. At King Abdul Aziz University Hospital (KAUH), first quarter 2023 data revealed that 8% of tonsillectomy patients presented to the emergency department with postoperative bleeding, of whom 28% required immediate operative intervention, while the remaining 72% were managed medically. A multidisciplinary team conducted a root cause analysis and identified poor oral intake and non compliance with nutritional guidelines as the most common contributing factors. These issues were found to be largely preventable through improved patient education and structured postoperative follow up. In response, the team developed a comprehensive workflow centered on telenursing based follow up. Key components included the creation of a standardized discharge card outlining “when to go to the emergency department,” development of triage calling forms, and implementation of scheduled follow up calls on postoperative days 2, 5, and 9. A pilot study was conducted to refine the tools and processes. ENT surgeons were engaged throughout the initiative, and targeted training was provided to nursing staff on communication protocols, assessment questions, and appropriate escalation pathways. Ongoing monitoring of staff compliance and monthly KPI tracking were integrated to ensure sustainability.
Objectives: This study aims to evaluate the effectiveness of structured telenursing follow up in enhancing post discharge care for post tonsillectomy patients.
Outcome: % of post Tonsillectomy Bleeding incidences were significantly decreased from 8% to 1%.
