Improving the management of suspected tonsillitis and peritonsillar abscess referred to ENT - a coronavirus disease 2019 service improvement

Abstract

Background: The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the management of suspected tonsillitis or quinsy were implemented in our centre.

Methods: A retrospective audit was performed of acute referrals to ENT of patients with suspected tonsillitis, peritonsillar cellulitis or quinsy, during the 10 weeks before (group 1) and 10 weeks after (group 2) implementation of the new standard operating procedures.

Results: Group 2 received fewer referrals. Fewer nasendoscopies were performed and corticosteroid use was reduced. The frequency of quinsy drainage performed under local anaesthetic increased, although the difference was not statistically significant. Hospital admission rates decreased from 56.1 to 20.4 per cent, and mean length of stay increased from 1.13 to 1.5 days. Face-to-face follow up decreased from 15.0 to 8.2 per cent, whilst virtual follow up increased from 4.7 to 16.3 per cent. There were no significant differences in re-presentation or re-admission rates.

Conclusion: Management of suspected tonsillitis or quinsy using the new standard operating procedures appears to be safe and effective. This management should now be applied to an out-patient setting in otherwise systemically well patients.

Keywords: Coronavirus; Otolaryngology; Pandemics; Peritonsillar Abscess; Quality Improvement; Tonsillitis.

Fig. 1.

Intravenous (IV) treatment strategies for groups 1 and 2 (pre- and post-implementation of new standard operating procedures, respectively) (*p < 0.05).

Fig. 2.

Procedures performed for quinsy drainage under local anaesthetic, for groups 1 and 2 (pre- and post-implementation of new standard operating procedures, respectively) (*p < 0.05).