Main theme: general
ABSTRACT:
Background: “Getting It Right First Time” recommends a 2-4 hour postoperative stay following a tonsillectomy. We sought to establish whether our unit achieves this and to identify clinical and systemic barriers to early discharge.
Methods: Medical and nursing notes review of all 94 children undergoing day-case tonsillectomy (+/- other procedures) between September and December 2025.
Results: Overall, 28.7% of patients went home at their earliest discharge time, and 46.3% within 3.5 hours. Early discharge was more common at weekends (53.8%) than weekdays (10.9%) and, paradoxically, more common when a 2-hour stay was planned (38.6%) than 3-hours (13.5%). Children aged 2–3 years had the lowest early discharge rates. Overall, 91.1% of delays were deemed avoidable. The most common single factor was pharmacy delay, but in 56.7% more than one factor led to delay. Intracapsular tonsillectomy achieved early discharge more often (47.7%) than extracapsular (33.3%).
Conclusion: Tonsillectomy discharge at 2 hours is achievable, and most delays are at least potentially avoidable. The high success rates for weekend lists suggest that cohorting high-volume surgery improves flow. Early prescribing and dispensing of discharge medication, day-case anaesthesia, intracapsular techniques, and an appropriate staff mindset could all lead to better overall resource utilisation and shorter waiting times.