Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-19T04:18:46.601Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementing a guideline for acute tonsillitis using an ambulatory medical unit

Published online by Cambridge University Press:  10 April 2019

C Perkins ,
F Ray Brown ,
K Pohl ,
O McLaren ,
J Powles  and
R Thorley
C Perkins*
Affiliation:
Department of ENT, Torbay and South Devon NHS Foundation Trust, Torquay, UK
F Ray Brown
Affiliation:
Department of ENT, Torbay and South Devon NHS Foundation Trust, Torquay, UK
K Pohl
Affiliation:
Department of ENT, Torbay and South Devon NHS Foundation Trust, Torquay, UK
O McLaren
Affiliation:
Department of ENT, Torbay and South Devon NHS Foundation Trust, Torquay, UK
J Powles
Affiliation:
Department of ENT, Torbay and South Devon NHS Foundation Trust, Torquay, UK
R Thorley
Affiliation:
Department of ENT, Torbay and South Devon NHS Foundation Trust, Torquay, UK
*
Author for correspondence: Miss Clare Perkins, Department of ENT, Torbay Hospital, Newton Road, Torquay Devon TQ2 7AA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.

Methods

A retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.

Results

The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.

Conclusion

The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.

Keywords

TonsillitisPatient AdmissionLength Of Stay
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 133 , Issue 5 , May 2019 , pp. 386 - 389
Copyright
Copyright © JLO (1984) Limited, 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Miss C Perkins takes responsibility for the integrity of the content of the paper

Presented at the South West Regional Audit Meeting, 26 January 2018, Exeter, UK.

References

1Millington, A, Phillips, J. Current trends in tonsillitis and tonsillectomy. Ann R Coll Surg Engl 2014;96:586–9Google Scholar
2Bird, J, Biggs, T, Schulz, C, Lower, N, Faris, C, Repanos, C. Implementation of the Portsmouth tonsillitis protocol. Int J Surg 2014;11:634Google Scholar
3Mohammed, H, Jin, X, Masterson, L, Wickstead, M. Ambulant management of acute tonsillitis in adult patients, a study on 330 patients. Clin Otolaryngol 2017;42:897–901Google Scholar
4National Institute for Health and Care Excellence. Sore throat (acute): antimicrobial prescribing (NICE Guideline 84). In: https://www.nice.org.uk/guidance/ng84/documents/draft-guidance [11 September 2018]Google Scholar
5Hayward, G, Thompson, M, Heneghan, C, Perera, R, Del Mar, C, Glasziou, P. Corticosteroids for pain relief in sore throat: systematic review and meta-analysis. BMJ 2009;358:b2976Google Scholar
6Ashman, A, Harris, R. Outpatient management of patients with acute tonsillitis and peritonsillar abscess in ninety adult patients. Clin Otolaryngol 2016;42:720–3Google Scholar
7Moore, M, Stuart, B, Hobbs, R, Butler, C, Hay, A, Campbell, J et al. Symptom response to antibiotic prescribing strategies in acute sore throat in adults: the DESCARTE prospective cohort study in UK general practice. Br J Gen Pract 2017;67:e634–42Google Scholar
8Banigo, A, Moinie, A, Bleach, N, Chand, M, Chalker, V, Lamagni, T. Have reducing tonsillectomy rates in England led to increasing incidence of invasive group A streptococcus infections in children? Clin Otolaryngol 2018;43:912–19Google Scholar
9Lau, A, Upile, N, Wilkie, M, Leong, S, Swift, A. The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991–2011. Ann R Coll Surg Engl 2014;96:307–10Google Scholar
10National Institute for Health and Care Excellence. Evidenced Based Interventions: Consultation Document. In: https://www.engage.england.nhs.uk/consultation/evidence-based-interventions/user_uploads/evidence-based-interventions-consultation-document-1.pdf [11 November 2018]Google Scholar
11National Institute for Health and Care Excellence. Costing statement: Implementing the NICE guideline on transition between inpatient hospital settings and community or care home settings for adults with social care needs (NG27). In: https://www.nice.org.uk/guidance/ng27/resources/costing-statement-2187244909 [13 September 2018]Google Scholar
12Bird, J, Biggs, T, King, E. Controversies in the management of acute tonsillitis: an evidence-based review. Clin Otolaryngol 2014;39:368–74Google Scholar
13National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management (NICE guideline 51). In: https://www.nice.org.uk/guidance/ng51 [14 September 2018]Google Scholar
14Abhilash, A. Bacteriological profile and antibiotic sensitivity pattern of acute tonsillitis in adults in a tertiary care centre. Indian J Appl Res 2018;8:12–13Google Scholar