Creation of "Tonsil Texts" Program to Provide Support and Education to Caregivers during Postoperative Tonsillectomy Period (Spotlight Poster)

Background: Pediatric patients account for 26.8 million emergency department (ED) visits annually, costing an estimated 7.8 billion dollars. The otolaryngology (ENT) clinic identified 179 ED visits in 2022 and 130 ED visits in 2021 within 30 days of tonsillectomy. Extensive post-op education is provided during clinic visits, although retention remains variable, contributing to preventable ED visits.

Purpose: To utilize a text messaging program, Tonsil Texts, to decrease ED visits after tonsillectomy, provide support and education to caregivers, and provide access to contact ENT with concerns.

Methodology: This quality improvement project was one implementation strategy in a larger health literacy initiative. Staff conducted a root cause analysis and created a key driver diagram to identify barriers. Two barriers to caregiver retention of information were identified, including delay between visit and surgery and the amount of information provided. To address these barriers, Tonsil Texts were initiated. Systemwide analytics built a report including all patients undergoing tonsillectomy, which communicated with PatientEXP software to send automated text messaging in English or Spanish. All patients were enrolled beginning December 2022, but could opt-out. Families received post-op video instructions on the child's surgery date, providing time to watch while their child was in the operating room. Additional messages were sent on post-op days 2, 4, and 7 with reinforcement of care and encouragement. All messaging included a hyperlink to the patient portal and the clinic phone number. A survey was sent on day 14, indicating the end of standard messaging and post-op period, and requesting feedback on program timeline and messaging.

Results: Our ENT surgeons have completed 729 tonsillectomies in 2023, with 80 patients returning to the ED within 30 days (10.97%). This shows trending improvement from 2022 where 13.7% of patients returned (n=1299), and 2021 where 13.4% returned (n=967). As of June 2023, 96.15% of caregivers found Tonsil Texts helped to manage their child’s pain after surgery (n=78). 98.72% found the Tonsil Texts information was useful and delivered on the appropriate days and times. 97.44% indicated that the messaging helped them know who to contact for concerns. Caregivers reported positive feedback suggesting the texts "helped [her daughter] cope," were received "right on time," and came through "just before [she] wanted to call and ask a question.” Due to continued calls about ear pain, an expected post-op finding, messaging was updated. Continued review of feedback and nursing calls will guide Tonsil Texts changes.

Implications: Caregivers often struggle managing postoperative pain, hydration, and other concerns for up to 2 weeks after surgery. Tonsil Texts reinforces education on postoperative care symptoms and management, normalizing their child’s experience, and providing easy access to the ENT department if additional concerns arise. Nurses may work with their IT departments to create automated processes, such as Tonsil Texts, that support the needs of patients and families. Implementing health literacy practices in post-surgical teaching and innovating methods to improve information retention can improve patient outcomes and reduce costs.