Hoade Lucy M S, Rees Elliott N
Department of Ear, Nose and Throat Surgery, University Hospital Wales, Cardiff, Wales CF14 4XW, UK.
Polytrauma Unit, University Hospital Wales, Cardiff UK.
Surg Pract Sci. 2023 Aug 21;14:100214. doi: 10.1016/j.sipas.2023.100214. eCollection 2023 Sep.
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.
All cases of acute tonsillitis ( = 127) and peritonsillar abscess ( 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.
Introduction of a tonsillitis management protocol resulted in a reduction in mean LOS from 22 to 12 h ( = 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 ( = 0.017) with use of the SDEC. Readmission rates remained low through all audit cycles.
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.
扁桃体炎给医疗服务带来了巨大压力，近年来住院率不断上升。迫切需要采取策略，通过安全的替代住院方案来缓解对二级医疗前所未有的需求。这个质量改进项目展示了一种早期出院途径与耳鼻喉科主导的外科同日急诊护理（SDEC）单元相结合的发展情况。
在两个干预阶段（2021年8月至10月和2022年6月至10月）对所有急性扁桃体炎（n = 127）和扁桃体周围脓肿（n = 43）病例进行了回顾，每个阶段都包括一次回顾性基线审计，随后进行干预后前瞻性审计周期，以评估住院时间（LOS）和再入院率。
引入扁桃体炎管理方案后，平均住院时间从22小时降至12小时（P = 0.004）。在第二次基线审计中，平均住院时间恢复到20小时。进一步的审计周期表明，使用SDEC后，平均住院时间持续降至13小时（P = 0.017）。在所有审计周期中，再入院率一直很低。
急性扁桃体炎患者可以通过早期出院途径得到安全管理。使用SDEC来实施该方案可减轻前门服务的压力，缩短住院时间，且不影响再入院率。
