Telephone-Based Triage After Pediatric Tonsillectomy: A Retrospective Analysis.

Abstract

Objective: To describe posttonsillectomy telephone triage utilization and short-term outcomes in a single tertiary pediatric system.

Study design: Retrospective cohort study.

Setting: Tertiary care children's hospital.

Methods: All patients aged 0 to 18 years (N = 12,167) who underwent tonsillectomy between January 2020 and December 2024 were included. Primary outcomes included timing and type of telephone calls, emergency department (ED) visits, and bleeding events within 30 postoperative days. Secondary outcomes included intervention rates based on presentation pathway (telephone triage vs direct ED presentation).

Results: Among 12,167 patients, 2483 (20.4%) contacted telephone triage within 30 days. Of callers, 2273 (91.5%) were managed without ED referral; 210 (8.5%) were referred to the emergency department. Of bleeding related calls, 111 (66.9%) were managed without ED referral, and 41/60 (68.3%) patients referred to the ED did not require surgical intervention. Telephone triage demonstrated 91.5% effectiveness and prevented 2273 ED visits. Patients utilizing telephone-based triage were more likely to have Medicaid insurance (P < .001) and live in high-disadvantage neighborhoods (P < .001).

Conclusions and relevance: Telephone-based triage is an effective measure to help reduce ED visits for pediatric posttonsillectomy patients. The majority of patients who utilized telephone-based triage were successfully managed at home across all types of complications. There is a potential $158,000 to $360,000 in healthcare savings seen after implementing this program. High-disadvantage patients were more likely to use telephone-based triage but achieved similar outcomes to low-disadvantaged peers. In this cohort, a structured phone-triage pathway safely managed most concerns without ED referral.