Fahad Ahmad
Introduction
Tonsillitis is a high-volume, often low-acuity presentation to emergency departments contributing to patient flow pressures. An ambulatory tonsillitis pathway was introduced to sSDEC aiming to improve treatment and patient care, and decrease admissions.
Methods
A retrospective observational study was conducted over 12 weeks (October 2025–January 2026) followed by the implementation of a tonsillitis pathway using Plan-Do-Study-Act (PDSA) methodology over a 4-week period. sSDEC streamed suitable patients from A&E where the Advanced Clinical Practitioner (ACP) and ENT team used a structured proforma to clerk and manage patients, escalating those with red flag features. Following the Portsmouth Protocol, patients received standardised treatment and were reviewed after 2–4 hours. Haemodynamically stable patients tolerating oral intake were discharged with antibiotics, a patient information leaflet, and seven-day open access to sSDEC.
Results
Preliminary data demonstrates a 100% reduction in ED four-hour breaches (17/62 27.4% vs 0/9 0%). Treatment protocol compliance has increased from 22.6% (14/62) to 89% (8/9). Whilst a percentage increase in admissions was noted (14/62 22.6% vs 5/9 56%), the average length of admission (hours) has decreased (31.8 vs 31.1). No significant safety concerns or adverse events have been identified so far.
Conclusions
With strict inclusion criteria, an ambulatory tonsillitis pathway is an effective and safe approach to managing tonsillitis improving adherence to evidence-based management, reducing ED congestion, and shortening length of stay. Second PDSA cycle interventions will include earlier referral cut-off times to sSDEC and addressing specific reasons for admission despite active observation.
Authors
Fahad Ahmad, Annalie Baker, Nicola Wooles, Emma Green
Warwick Hospital, Warwick, United Kingdom