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

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.