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. 2023 Aug 21:14:100214.
doi: 10.1016/j.sipas.2023.100214. eCollection 2023 Sep.

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

Lucy M S Hoade  1 , Elliott N Rees  2
Affiliations

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

Lucy M S Hoade et al. Surg Pract Sci. .

Abstract

Background: Tonsillitis places a significant strain on healthcare services, with rising admission rates over recent years. There is an urgent need for strategies to alleviate unprecedented demand on secondary care via safe alternatives to hospital admission. This quality improvement project demonstrates development of an early discharge pathway in combination with an ENT-led Surgical Same Day Emergency Care (SDEC) unit.

Methods: All cases of acute tonsillitis (n = 127) and peritonsillar abscess (n = 43) were reviewed across two intervention phases (Aug-Oct 2021 and June-Oct 2022), which each involved a retrospective baseline audit, followed by post-intervention prospective audit cycles to assess hospital length of stay (LOS) and readmission rates.

Results: Introduction of a tonsillitis management protocol resulted in a reduction in mean LOS from 22 to 12 h (p = 0.004). Mean LOS reverted to 20 h in the second baseline audit. Further audit cycles demonstrated a sustained reduction in mean LOS to 13 h (p = 0.017) with use of the SDEC. Readmission rates remained low through all audit cycles.

Conclusion: Patients with acute tonsillitis can be safely managed via an early discharge pathway. Use of SDEC to deliver this protocol reduces pressure on front-door services, reduces LOS and does not affect readmission rate.

Keywords: Acute admissions pathway; Length of stay; Peritonsillar abscess; Quality improvement; Tonsillitis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Algorithm demonstrating the management protocols for acute tonsillitis and peritonsillar abscess (Quinsy). ED = Emergency Department; ENT = Ear, Nose & Throat; IV = intravenous; FBC = full blood count; U&E = urea & electrolytes; CRP = C-reactive protein; ANBX = antibiotics; DEX = dexamethasone.
Fig 2
Fig. 2
Graph demonstrating the change in length of stay and readmission rate (within 14 days) before and following two intervention phases. * = p < 0.05.
See this image and copyright information in PMC

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