Decreasing Seven-Day Revisits After Pediatric Tonsillectomy: A Multidisciplinary and Comprehensive Unit-Based Safety Program (CUSP)-Driven Quality Improvement Initiative

Pediatric tonsillectomy is among the most common ambulatory procedures in children. An important aspect of serving this patient population is appropriate post-operative care and follow-up. In early 2025, our institution identified a seven-day revisit rate in post-tonsillectomy patients exceeding those of similar institutions nationally. We identified possible areas of improvement, including improved hydration, post-operative pain management, and clear instructions for post-operative care. Objective: Our goal was to reduce the seven-day revisit rate ≥1% by December 31, 2025, for patients ages 0-21, through the implementation of a perioperative dehydration-prevention and pain-optimization bundle. This intervention included an intraoperative medication protocol, standardized discharge materials, and communication optimization within a Comprehensive Unit-based Safety Program (CUSP) framework. Methods: This study was conducted at WVU Medicine Golisano Children's Hospital in Morgantown, West Virginia. A multidisciplinary team, including anesthesiology, otolaryngology, nursing, and quality-trained staff, applied three sequential Plan-Do-Study-Act (PDSA) cycles under CUSP governance. Our intraoperative pathways involved administration of a crystalloid bolus ≥30 ml/kg (max 1.5 L), as well as acetaminophen (15 mg/kg, max 1000 mg) and dexamethasone (0.5 mg/kg, max 20 mg) dosing. Goals for our Post-Anesthesia Care Unit (PACU) encompassed scheduled ibuprofen dosing 10 mg/kg (max 400 mg), standardized discharge packets containing a 48-hour hydration checklist and dye-free medication calendar, as well as planned check-ins and updates with family by the surgical team. We performed monthly reviews of revisit rates along with process and balancing measures. Results: Early into implementation, our interventions identified pain and dehydration as predominant factors for revisits. As the study progressed, we observed that our adopted interventions led to standardized intraoperative fluids and analgesia, improved discharge clarity, and aligned communication workflows with caregiver expectations. Conclusions: A pragmatic perioperative-to-home bundle focused on hydration, multimodal analgesia, and practical discharge instructions showed early feasibility for reducing short-term revisits (3.75-2.16%). Longitudinal monitoring will evaluate outcome durability and assess the sustainability of improvements.