Clinical Outcomes
Clinical outcomes are changes in health that can be both measured and followed. They go beyond simply providing safe care. They can take the form of many different aspects of health care. Clinical outcomes, however, should focus on what is important to the patient and their caregivers. Some examples of clinical outcomes include days with symptoms of illness, cancer freedom, quality of life or reduced days in the hospital. Other clinical outcomes could include preventive measures, such as vaccinations, or measures to maximize health, such as healthy weight management.
What Is the Project and Why Is it Important?
Removing tonsils (tonsillectomy) is one of the most performed pediatric surgeries. More than 500,000 procedures are done annually in the U.S. and over 3,500 are done each year at Nationwide Children’s. Across the country, acute bleeding after this procedure occurs in about 2%–5% of cases. In some cases, children experiencing post-operative bleeding require an urgent return to the operating room (RTOR) to control bleeding.
In 2019, the Pediatric Ear Nose & Throat (Otolaryngology) team at Nationwide Children’s started a large quality improvement project to reduce serious bleeding after tonsil surgery (tonsillectomy). The team wanted to do more than meet national benchmarks. They worked to improve the standard of care at every stage, from pre-surgery evaluation to Emergency Department care after surgery.
This project included Pediatric Ear Nose & Throat, Emergency Medicine, Hematology, Pharmacy, Perioperative Services, Anesthesia, Nursing, Epic/IS and Quality Improvement leadership to improve the safety and quality of care for children undergoing tonsillectomy.
How Are We Doing?
Over the past seven years, Ear Nose & Throat has reduced unplanned return to the operating room for post-tonsillectomy bleeding. Since the project began, RTOR events have decreased by more than 89%. As a result, more than 535 children avoided additional surgery through the end of 2025.
At the same time, the team successfully reduced opioid prescriptions after tonsillectomy by 93%. This shows that improved pain management and safer prescribing practices can occur alongside improved surgical outcomes.
The project also strengthened collaboration between inpatient, outpatient, surgical and emergency department teams. This ensures more standardized and timely care for children with post-operative bleeding concerns.
What Are We Doing to Improve?
Pediatric Ear Nose & Throat made several changes to reduce bleeding after tonsillectomy. These included:
- Tracking surgeon outcomes and reviewing cases on a regular basis
- Using intracapsular surgical technique when appropriate
- Developing a new pre-operative bleeding risk assessment
- Using evidence-based changes for pain management after surgery
- Partnering with the Emergency Department to implement the use of tranexamic acid (TXA), administered as a breathing treatment to support non-surgical management of bleeding when appropriate
Together, these efforts created a reliable system focused on preventing complications, identifying risk early and ensuring timely treatment when bleeding occurs.
How Can Patients and Families Help?
- Review after-surgery instructions carefully: Follow all recommended discharge instructions.
- Use medications safely: Give pain medications exactly as directed by your care team and avoid medications not recommended by your surgical team.
- Stay hydrated: Encourage your child to drink fluids regularly during recovery to support healing; fluid intake is more important than solid foods.
- Watch for signs of bleeding: Watch closely for bleeding, frequent swallowing, vomiting blood or coughing up blood after surgery. Contact your care team immediately or go to the Emergency Department if any concerns arise.
- Ask questions: Talk openly with your child’s care team about pain management, expected recovery and when to seek emergency care. Call your child’s surgical team if you have any questions or concerns.