Principles of Health Care Quality Improvement

Question: Describe about the Principles of Health Care Quality Improvement. Answer: Tonsillectomy is one of the most frequently performed surgeries in children but an accurate determination of its indications demands broad research of the childs medical history, evaluation of vital information related to the surgery, and consideration of post-surgical complications (1). As a parent of a 3 years old one should look out for the indications for tonsillectomy. A wait-and-see approach can be considered for the child who suffers from few throat infections. But for severe recurrent tonsillitis talking with the doctor about the potential benefits of operation for the child as well as the expenses and dangers of the surgery is essential. For children with recurrent tonsillitis, tonsillectomy can significantly mend the quality of life. Enlarged tonsils can cause clogged upper air-passage and breathing difficulties. Surgery can help relieve these problems (1). As a parent, it is emotionally and physically draining to see a 3-year-old child in such pain. A common parameter for tonsillectomy is at least three documented episodes in each of the previous three years or five documented occurrences in each of the past two years or seven documented incidence of a throat infection in the former year with a fever higher than 100.9F. Physicians usually recommend surgery to eliminate tonsils when a child has recurrent infections of the tonsils that are triggering severe complications or are disturbing a child's quality of life. A decision about surgery should be made with the otolaryngologist and based on the child's health and well-being (2). For taking the verdict of tonsillectomy for a 3-year-old some of the following serious medical problems should be considered: Tonsillitis that persists longer than 3 months regardless of medicines Congested airways which can causesleep apnea Ache in swallowing Tonsils that bleed worryingly (3) In addition to the above conditions, a documentation of recurrent tonsillitis can be very useful to decide the need for tonsillectomy. Documentation for recurrent tonsillitis comprises the manifestation of a sore throat and outcomes from a doctors analysis of fever, tonsil size, tonsillar or pharyngeal erythema, cervical adenopathy, tonsillar exudate, microbiological examination results (positive culture for group A -haemolytic streptococcus) etc. Additional documentation includes absences from daycare, tiredness and spread of infection within the family (3). Both harms and benefits of the surgery should be considered before the decision is made. The two main preoperative risk factors are disordered breathing during sleep and coagulopathies. But with the help of modern medical science, these jeopardise can be easily overcome. The stated rates of postoperative haemorrhage needing blood transfusion diverge from 0% to 2.3%. Demises due to postoperative haemorrhage are not scientifically documented on an international level, and any data that have been published till now on this matter are mainly hypothetical (2). Evidence advises that the most frequently and severely affected children have decent improvement with tonsillectomy and a notable improvement in the quality of life. After surgery, the child may experience tiredness for quite a few days and then gradually becomes more energetic. The child should be capable of going back to daycare or school within 1-2 weeks and return to complete doings in 2-3 weeks (4). The decision of tonsillectomy for a toddler should be made considering the above facts. References Stuck BA, Windfuhr JP, Genzwrker H, Schroten H, Tenenbaum T, Gtte K. Die Tonsillectomy in children. Dtsch Arztebl. 2008;105(49):852-61. Schymik FA, Smith EM, Voepel-Lewis T. Parental Analgesic Knowledge and Decision Making for Children With and Without Obstructive Sleep Apnea After Tonsillectomy and Adenoidectomy. Pain Management Nursing. 2015 Dec 31;16(6):881-9. Goldstein NA, Stewart MG, Witsell DL, Hannley MT, Weaver EM, Yueh B, Smith TL, Orvidas LJ, TO TREAT Study Investigators. Quality of life after tonsillectomy in children with recurrent tonsillitis. Otolaryngology-Head and Neck Surgery. 2008 Jan 31;138(1):S9-16. Thong G, Davies K, Murphy E, Keogh I. Significant improvements in quality of life following paediatric tonsillectomy: a prospective cohort study. Irish Journal of Medical Science (1971-). 2016 Jan 18:1-7.