Implementing a guideline for acute tonsillitis using an ambulatory medical unit

Perkins, Clare; Brown, Fraser; Pohl, Keith; McLaren, Oliver; Powles, James; Thorley, Rachel M. S.

doi:10.1017/s0022215119000380

Cited by 3 publications

(2 citation statements)

References 9 publications

(13 reference statements)

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“…Perkins et al . 7 also showed similar results with their protocol, halving the length of admission and more than halving the admission rate. Larger studies have similarly demonstrated a decrease in admission rate with the introduction of an ambulant management pathway.…”

Section: Resultssupporting

confidence: 56%

“…This approach has been validated by Harris and Ashman 6 who demonstrated a 42 per cent early discharge rate in patients treated with a similar protocol, with zero re-admissions. Perkins et al 7 also showed similar results with their protocol, halving the length of admission and more than halving the admission rate. Larger studies have similarly demonstrated a decrease in admission rate with the introduction of an ambulant management pathway.…”

Section: Tonsillitismentioning

confidence: 64%

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Ambulatory management of common ENT emergencies – what's the evidence?

2021

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Objectives The global pandemic of coronavirus disease 2019 has necessitated changes to ‘usual’ ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. Methods A literature review was performed, searching all available online databases and resources. The Medical Subject Headings ‘tonsillitis’, ‘pharyngotonsillitis’, ‘quinsy’, ‘peritonsillar abscess’ and ‘epistaxis’ were used. Papers discussing out-patient management were reviewed by the authors. Results Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. Conclusion In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.

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Section: Resultssupporting

confidence: 56%

Section: Tonsillitismentioning

confidence: 64%

Ambulatory management of common ENT emergencies – what's the evidence?

2021

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Developing a novel tonsillitis pathway to reduce pressures on front-door services: A multi-phase quality improvement project in a large UK teaching hospital

Hoade,

Rees

2023

Surgery in Practice and Science

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Implementation of an acute tonsillitis management protocol within a clinical decisions unit

Balai

Bhamra

Gupta

et al. 2021

annals

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Introduction With tonsillectomy surgery subject to increasingly strict commissioning criteria over the past 20 years in the UK, the total number of admissions for acute tonsillitis has been rising steadily. Multiple single-centre studies have demonstrated how introduction of a standardised management protocol can be effective in improving the delivery of treatment for acute tonsillitis in the emergency department. Methods Using a novel approach, we aimed to implement an acute tonsillitis management protocol within a formal clinical decisions unit (CDU) pathway. Following a retrospective baseline audit, we carried out two post-intervention cycles of data collection to assess safety and efficacy. Results The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (U = 86, p = 0.004) and second (z = 2.959, p = 0.003) audit cycles. Admission rate was reduced from 0.79 to 0.44 in the first cycle, representing a 44.6% relative risk reduction [95% confidence interval (CI) 0.304–1.012; p = 0.0547]. Admission rate remained reduced at 0.48 in the second cycle, with a relative risk reduction of 39.2% compared with baseline (95% CI 0.380–0.972; p = 0.038). Conclusions Utilisation of the CDU led to an improvement in the delivery of initial treatment, an extended period of observation and subsequently a greater percentage of patients being discharged. An acute tonsillitis management protocol within a CDU appears to be a safe and effective model and is now standard practice in our hospital.

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Implementing a guideline for acute tonsillitis using an ambulatory medical unit

Cited by 3 publications

References 9 publications

Ambulatory management of common ENT emergencies – what's the evidence?

Ambulatory management of common ENT emergencies – what's the evidence?

Developing a novel tonsillitis pathway to reduce pressures on front-door services: A multi-phase quality improvement project in a large UK teaching hospital

Implementation of an acute tonsillitis management protocol within a clinical decisions unit

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