An evaluation into the impact of GIRFT’s interventions, resources and products on day case rates for paediatric adenotonsillectomy shows a marked improvement in day case delivery in the years since GIRFT began its work in the ear, nose and throat (ENT) specialty, without evidence of compromised patient safety or poorer outcomes.
GIRFT’s data analysis shows that the day case rate for paediatric adenotonsillectomy rose from 55% in 2015/16 to 87% by 2024/25, far exceeding the benchmark of 70% set by the British Association of Day Surgery (BADS).
Emergency readmissions remained low and stable throughout the same period, reintervention due to haemorrhage remained consistently low with no upward trend, and there were fewer day case patients converted to an overnight stay.
GIRFT has been working to reduce unwarranted variation in ENT services since 2016, when clinical leads began visiting all ENT providers in England to examine their data around procedures, including paediatric adenotonsillectomy.
The GIRFT national report for ENT was published in 2019, with a key recommendation to increase day case rates for tonsillectomy surgery to help improve patient flow and create a better experience for many.
Following on from the national report, the team has worked with stakeholders to release a suite of guidance products designed to support providers to improve safe and effective paediatric day case adenotonsillectomy care delivery. GIRFT has also launched a number of implementation interventions – such as the High Volume Low Complexity (HVLC) programme and a focused support offer – to support providers to implement changes in clinical practice in ENT.
The new evaluation looks at the timing of GIRFT products, implementation support and gateway reviews against trends in day case rates, emergency readmissions, reinterventions due to haemorrhage, and intended day case management and overnight stay conversion for young patients, covering the period from 2015/16 to 2024/25.
It shows that:
- The day case rate for paediatric adenotonsillectomy rose from 55% in 2015/16 to 64% by 2019/20, prior to the COVID-19 pandemic. Further increases were observed from 2020/21 onwards, with the day case rate surpassing the national 70% benchmark in 2021/22 and reaching levels above 80% in 2023/24; by 2024/25 the day case rate was 87%.
- The 30-day emergency readmission rate remained low and relatively stable, with annual values remaining within a narrow band of 5.7–7.1%.
- The reintervention rate for postoperative haemorrhage was consistently low, with annual values ranging between 4.1–5.7%
- The proportion of paediatric adenotonsillectomy procedures managed as intended day cases increased from 67% in 2015/16 to more than 85% by 2024/25, while the proportion of intended day case procedures requiring overnight stay reduced from 27% to below 10%.
Su De, GIRFT’s paediatric ENT clinical lead, said:
“Day case rates for paediatric adenotonsillectomy have surpassed national expectations for day case rates and our NHS teams should be commended for their work on this. What’s more, this evaluation clearly shows that the improvements have been delivered safely, consistently and in alignment with national clinical improvement initiatives. Going forwards, this offers a robust platform for continued optimisation of paediatric day case surgical care.”
