ATLANTA – Same-day surgery for children with otitis media who need tympanostomy tubes appears to improve access and efficiency of care, according to results of a small study presented at the annual meeting of the National Association of Pediatric Nurse Practitioners.
The Same-day Surgery Program allows consultation for tympanostomy tube placement and surgery to be completed in one extended appointment after referral from a primary care provider, said Allison Rose, a certified nurse practitioner at the Ann & Robert H. Lurie Children’s Hospital of Chicago.
In a retrospective, matched series of 30 children with a median age of 16 months enrolled in the program and 30 controls with a median age of 18 months, children in the same-day program had significantly shorter total overall clinical visit and surgical encounter time (151 minutes [135-169 minutes]), compared with controls (196 minutes [169-234 minutes]). The average number of days from scheduling the primary care office visit to surgery was 7 (4-11 days) for the same-day surgery patients and 14 (6-21 days) for controls. Eight patients in each group were enrolled in Medicaid, and 22 had private insurance or managed care.
Parents also cited multiple advantages of the program, including less missed work, less missed school/day care, quicker resolution of the medical problem, ease for the toddler, and appointment availability. Disadvantages mentioned were unclear expectations for the day of surgery and longer appointment duration.
The investigators remarked that according to one study, nearly 7% of children have tympanostomy tubes by the age of 3 years, and going to day care doubles the risk. They also emphasized that children in rural areas or those who are underinsured may have problems obtaining access to care for such surgical treatment when it is indicated – delaying treatment and putting them at risk for complications of otitis media.
“Lurie Children’s Hospital’s Same-day Surgery Program for children in need of tympanostomy tubes rethinks the referral, evaluation, and treatment process of a low-risk procedure for a common problem,” Ms. Rose said in a later interview. “This program can streamline subspecialty access to care with high family satisfaction.”
The authors said they had no relevant financial disclosures.