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Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study

Artikel i vetenskaplig tidskrift
Författare Erik Odhagen
Ola Sunnergren
Anne-Charlotte Hessén Söderman
Johan Thor
Joacim Stalfors
Publicerad i European Archives of Oto-Rhino-Laryngology
Volym 275
Nummer/häfte 6
Sidor 1631–1639
ISSN 0937-4477
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för öron-, näs- och halssjukdomar
Institutionen för kliniska vetenskaper
Sidor 1631–1639
Språk en
Länkar dx.doi.org/10.1007/s00405-018-4942-...
www.ncbi.nlm.nih.gov/entrez/query.f...
https://gup.ub.gu.se/file/207481
Ämneskategorier Oto-rino-laryngologi

Sammanfattning

Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates.Six ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project's primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP.The QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis.The rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.

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