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

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 ca...

Full description

Saved in:
Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2021-10, Vol.103 (9), p.690-693
Main Authors: Balai, E, Bhamra, N, Gupta, K, Jolly, K, Barraclough, J
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Antibiotics
Clinical Decision-Making
Clinical Protocols
Critical Pathways
Data collection
Emergency Service, Hospital
Female
Humans
Male
Otolaryngology
Patients
Physicians
Quality control
Retrospective Studies
Tonsillitis
Tonsillitis - therapy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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. 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. The median number of initial treatments increased significantly from two of five at baseline, to three of five in both the first (  = 86,  = 0.004) and second (  = 2.959,  = 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;  = 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;  = 0.038). 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.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2021.0060