Casey John, Keidel Scott, Kudo Marissa, Chan Miriam
Department of Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA.
Department of Otolaryngology, OhioHealth Doctors Hospital, Columbus, USA.
Cureus. 2024 Jan 30;16(1):e53223. doi: 10.7759/cureus.53223. eCollection 2024 Jan.
A peritonsillar abscess (PTA) is a frequent reason for a visit to the emergency department. As there are no current published guidelines for medical versus surgical management, attending physicians vary among management tendencies, generating uncertainty among resident physicians. This project established a standard of care for managing patients with PTA and provided clear management guidelines to the emergency department, in collaboration with the otolaryngology department, at a community academic hospital.
Pre- and post-interventional, anonymous surveys were given to assess resident physician confidence in the management of PTA. A proposed management protocol was developed based on existing literature and approved by both the emergency medicine (EM) and otolaryngology (ENT) departments. The protocol was then disseminated during in-person didactic sessions to EM residents and ENT residents for use over a four-month interventional period.
The mean confidence level for all residents increased significantly after the implementation of the protocol (p<0.001). The increase in confidence level for "antibiotic selection for PTA" (p=0.72) and "inpatient PTA management" (p=0.20) was not statistically significant for the post-graduate year (PGY) 3 and 4 residents. The increase in confidence level was higher overall for PGY 1 and 2 residents (95% CI 2.25 ± 1.09, p<0.001) than for PGY 3 and 4 residents (95% CI 1.73 ± 1.09, p=0.003).
The implementation of a standardized protocol for the management of PTA proved to be an effective tool in assisting residents and improving their confidence. This study highlights the importance of establishing guidelines in clinical practice to promote consistent and evidence-based management strategies for PTA. By providing clear guidelines, this protocol enhances communication among healthcare providers and contributes to the delivery of high-quality care to patients with PTA.
扁桃体周围脓肿（PTA）是患者前往急诊科就诊的常见原因。由于目前尚无关于内科治疗与外科治疗的公开指南，主治医生的治疗倾向各不相同，这给住院医师带来了不确定性。本项目与一家社区教学医院的耳鼻喉科合作，制定了PTA患者的护理标准，并为急诊科提供了明确的治疗指南。
进行干预前和干预后的匿名调查，以评估住院医师对PTA治疗的信心。根据现有文献制定了一份拟议的治疗方案，并得到了急诊医学（EM）和耳鼻喉科（ENT）部门的批准。然后，该方案在面对面的教学课程中向EM住院医师和ENT住院医师进行了传播，供他们在为期四个月的干预期内使用。
方案实施后，所有住院医师的平均信心水平显著提高（p<0.001）。对于三年级和四年级住院医师，“PTA抗生素选择”（p=0.72）和“PTA住院治疗”（p=0.20）的信心水平提高没有统计学意义。一年级和二年级住院医师的信心水平总体提高幅度（95%CI 2.25±1.09，p<0.001）高于三年级和四年级住院医师（95%CI 1.73±1.09，p=0.003）。
事实证明，实施标准化的PTA治疗方案是帮助住院医师并提高其信心的有效工具。本研究强调了在临床实践中建立指南对于促进PTA的一致和循证治疗策略的重要性。通过提供明确的指南，该方案加强了医疗服务提供者之间的沟通，并有助于为PTA患者提供高质量的护理。
