Quality Improvement in Otologic Surgery Postoperative Instructions

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 = 0.216 [-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 = 0.641 [0.011, 1.271]), and there were fewer critiques per patient (0.09 versus 0.15, d = -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 = -0.606 [-1.112, -0.099]) toward questions regarding medications (27.5% versus 6.7%, d = 0.921 [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.