Quality Improvement in Otologic Surgery Postoperative Instructions

Abstract

Supplemental Digital Content is available in the text Objective: To examine and improve patient satisfaction with otologic surgery postoperative instructions. Study Design: Patients undergoing outpatient otologic surgery were compared over two different time periods, before (phase 1) and after (phase 2) modifying postoperative instructions. Key-informant interviews were conducted by phone on postoperative day 7. All patient-initiated communications after surgery were documented. Setting: Tertiary, academic hospital. Patients: Patients undergoing outpatient otologic surgery. Interventions: Otologic surgery. Main Outcome Measures: Satisfaction ratings of different postoperative instruction categories (1–10, completely useless to perfectly helpful), including wound care, pain medication, non-pain medication, showering and bathing, activity restrictions, diet restrictions, follow-up appointment, and contact for questions; comments/critiques from patients; and patient-initiated communications. Results: Seventy eight patients were included in phase 1 and 52 in phase 2. Patient characteristics and distribution of surgeries were similar between phases. Rating for instructions were high in both phases (phase 1: 8.98[1.50], phase 2: 9.27[1.04], d\u200a=\u200a0.216 [−0.271, 0.698]). More patients in phase 2 thought the instructions were adequate and clear (80.0% versus 55.6% in phase 1, d\u200a=\u200a0.641 [0.011, 1.271]), and there were fewer critiques per patient (0.09 versus 0.15, d\u200a=\u200a−0.537 [−1.034, −0.040]) compared with phase 1. There was a shift in phase 2 communications away from wound care questions (17.5% versus 38.9%, d\u200a=\u200a−0.606 [−1.112, −0.099]) toward questions regarding medications (27.5% versus 6.7%, d\u200a=\u200a0.921 [0.325, 1.516]). Conclusion: An evidence-based postoperative instructions template led to more patients believing that the instructions were clear, fewer critiques being given, and a shift toward more actionable questions rather than those with answers already addressed in written instructions.