Ambulatory management of common ENT emergencies - what's the evidence?

C J Heining,A Amlani,J Doshi

doi:10.1017/s0022215121000554

Abstract

The global pandemic of coronavirus disease 2019 has necessitated changes to 'usual' ways of practice in otolaryngology, with a view towards out-patient or ambulatory management of appropriate conditions. This paper reviews the available evidence for out-patient management of three of the most common causes for emergency referral to the otolaryngology team: tonsillitis, peri-tonsillar abscess and epistaxis. A literature review was performed, searching all available online databases and resources. The Medical Subject Headings 'tonsillitis', 'pharyngotonsillitis', 'quinsy', 'peritonsillar abscess' and 'epistaxis' were used. Papers discussing out-patient management were reviewed by the authors. Out-patient and ambulatory pathways for tonsillitis and peritonsillar abscess are well described for patients meeting appropriate criteria. Safe discharge of select patients is safe and should be encouraged in the current clinical climate. Safe discharge of patients with epistaxis who have bleeding controlled is also well described. In select cases, tonsillitis, quinsy and epistaxis patients can be safely managed out of hospital, with low re-admission rates.

Highlights

The global pandemic of coronavirus disease 2019 (Covid-19) has placed unprecedented pressures on the National Health Service (NHS) and all professionals working within it
We wanted to take this opportunity to review the evidence for out-patient management of three common causes for in-patient referral to the ENT team: tonsillitis, peritonsillar abscess and epistaxis
Tonsillitis is often managed in the primary care setting, but up to 60 000 patients are admitted to UK hospitals each year with swallowing difficulties or systemic upset that cannot be managed by general practitioners.[4]

Summary

Introduction

The global pandemic of coronavirus disease 2019 (Covid-19) has placed unprecedented pressures on the National Health Service (NHS) and all professionals working within it. What was previously considered ‘usual’ care and ‘normal’ ways of working have changed in light of these extraordinary circumstances, and our professional bodies are encouraging us to consider alternative ways of caring for patients.[1,2] Minimising unnecessary in-patient admission has always been best practice[3] to minimise risks to patients (e.g. venous thromboembolism, infection, falls) and costs. The balance of risk versus benefit for hospital admission is even further skewed towards admission avoidance in the present pandemic environment. We wanted to take this opportunity to review the evidence for out-patient management of three common causes for in-patient referral to the ENT team: tonsillitis, peritonsillar abscess (quinsy) and epistaxis

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Conclusion