Post-tonsillectomy counseling: Less is more

December 1, 2006

A colorful, easy-to-read, two-page handout can decrease postoperative phone calls about minor side effects following the removal of tonsils, a study presented at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation has found.

The handout originated from the observation that medical residents received many late-night phone calls about post-tonsillectomy ear pain, a relatively minor concern, explained David Mandell, MD, a pediatric otolaryngologist at the Children's Hospital of Pittsburgh and supervisor of the project. The handout uses color coding to distinguish serious postoperative concerns such as bleeding (red) from minor concerns such as ear pain and low-grade fever (green).

"What we didn't understand is that parents get a long printout with small text describing what to expect in their children following tonsillectomy," said Dr. Mandell. "We learned that they paid more attention to handouts that include pictures and do not contain an excess of text and information." Dr. Mandell noted that several studies have shown that most pediatric surgical patients or their parents do not retain the information that is given to them in a postoperative consultation.

Even though the handout did not decrease the total number of calls to the hospital following tonsillectomy, some of the results suggested that parents were reading it, noted Alvin Ko, MD, a medical resident in the department of otolaryngology at Case Western University in Cleveland, Ohio, who developed the handout while he was a medical student at the University of Pittsburgh, where Dr. Mandell is an assistant professor. The number of calls per day about fever, a very common complaint, fell from 0.47 to 0.22 (p value 0.09). The number of calls per day about bleeding and poor oral intake both rose from 0.20 to 0.44 (p value 0.07).

"We designed the handout so that parents should be on alert for signs of symptoms in the red column, such as bleeding or poor oral intake," said Dr. Ko. "Consequently, we received many calls about these symptoms." One of the study's shortcomings was poor compliance among medical residents in logging all calls, Dr. Ko added.