Education Enhancements and Text Messaging Support After Adenotonsillectomy to Decrease Emergency Department Visits: A Quality Improvement Study

Purpose The purpose of this quality improvement (QI) project was to decrease preventable emergency department (ED) visits within 30 days post tonsillectomy and adenotonsillectomy surgery at a large, pediatric urban tertiary care hospital by 10% by December 31, 2023. Design & Methods Pediatric otolaryngology (ENT) nurses initiated a QI process to improve patient family education to decrease preventable ED visits. Plan–Do–Study–Act cycles tested improvements through utilization of visual aids during education, incorporating videos, and creating Tonsil Texts. Emergency Department visits were tracked on the department dashboard and surveys were collected on Day 14 texts. Annual change in the return to ED percentages between 2022 and 2023 was calculated with a two-proportion z-test. Surveys were reviewed for overall experience with Tonsil Texts. Results In 2023, 11.11% returned to the ED within 30 days, compared to 13.78% in 2022, reflecting a statistically significant improvement. This reduction is associated with an estimated cost savings of $78,100 for the organization. In 2023 ( n = 238), 96.6% of patient families’ found Tonsil Texts helped manage their child's pain, 97.5% found the information useful, 93.7% felt delivered at the appropriate times, and 95.4% indicated it helped them know who to contact for concerns. Families reported messaging improved their coping and confidence to care for their child. In 2024, ED visits remained significantly lower (10.24%), indicating sustainability with our interventions. Practice Implications Multifaceted improvements to in-clinic education, followed by postop Tonsil Texts, supported the information needs of patient families to reduce preventable ED visits.