Implementation of an Acute Tonsillitis Protocol in a District General Hospital: A Two-Cycle Audit

Area of Science:

• Otolaryngology
• Healthcare Management
• Clinical Audit

Background:

• Acute tonsillitis is a frequent cause of ear, nose, and throat (ENT) consultations, straining emergency and inpatient services.
• Lack of a standardized pathway at a district general hospital resulted in inconsistent patient reassessment and prolonged hospital admissions.
• This study aimed to assess the impact of a formalized acute tonsillitis protocol on clinical review timeliness and inpatient management efficiency.

Purpose of the Study:

• To evaluate the effectiveness of a standardized acute tonsillitis protocol in improving the speed of clinical reassessment.
• To determine if the protocol could lead to more efficient inpatient management and reduced length of stay (LOS).
• To analyze the impact on readmission rates and overall service bed utilization.

Main Methods:

• A two-cycle audit design was employed over comparable three-month periods.
• Adult patients (≥18 years) with a clinical diagnosis of tonsillitis referred to ENT were included.
• A protocol emphasizing reassessment within six hours was implemented, followed by data collection on time to second review, LOS, and readmissions.

Main Results:

• The median time to a second clinical review significantly decreased by 3.25 hours post-protocol implementation (p=0.031).
• A trend towards a reduced median LOS by six hours was observed, although not statistically significant (p=0.083).
• Two-week readmission rates showed a non-significant increase from 6.1% to 11.1% (p=0.49).

Conclusions:

• The standardized tonsillitis protocol enhanced the consistency and timeliness of inpatient reassessments.
• A clinically meaningful trend towards reduced length of stay was identified, suggesting potential for improved bed-day efficiency.
• Further monitoring and re-audits are recommended to ensure sustained adoption and evaluate long-term clinical and service impacts.