From the Guidelines
Patients with ENT conditions can be discharged from clinic follow-up when they demonstrate clinical stability for 24-48 hours, completion of treatment, and absence of complications, as well as ensuring access to social, mental health, and substance use disorder services, and scheduling an initial outpatient follow-up appointment within 48 hours of discharge, as recommended by the most recent guidelines 1.
Discharge Criteria
The decision to discharge an ENT patient from clinic follow-up should be based on the following criteria:
- Clinical stability for 24-48 hours before discharge
- Completion of treatment
- Absence of complications
- Ensuring access to social, mental health, and substance use disorder services
- Scheduling an initial outpatient follow-up appointment within 48 hours of discharge
Post-Discharge Care
Post-discharge care is crucial to prevent rehospitalization and ensure a smooth transition to outpatient care. This can be achieved by:
- Scheduling follow-up appointments before hospital discharge
- Assigning patient navigators or community health workers to patients with significant barriers to care
- Directly connecting patients to community services such as those addressing social determinants of health
- Checking in by telephone or text
- Facilitating home visits by community health workers, home nursing services, or equivalent support staff for the most vulnerable patients, as suggested by recent studies 1
ENT-Specific Considerations
For patients with specific ENT conditions, the following considerations should be taken into account:
- Acute conditions like otitis media or sinusitis: discharge after completion of antibiotic course and resolution of symptoms
- Tonsillitis: discharge after completing antibiotic therapy and showing no recurrence for 4-6 weeks
- Chronic conditions like allergic rhinitis: discharge when symptoms are well-controlled on maintenance therapy
- ENT surgeries: discharge after post-operative healing is complete, typically 4-6 weeks after procedures like tonsillectomy or septoplasty, with no evidence of complications, as generally recommended by clinical guidelines 1
From the Research
Discharge Guidelines for ENT Patients
The decision to discharge an ENT patient from the clinic depends on various factors, including the nature of the condition, its long-term management, and patient satisfaction.
- A study published in 1994 2 found that the majority of patients and general practitioners are happy for ongoing medical care to be continued without further ENT appointments if the nature of the condition and its long-term management is explained clearly.
- The same study also found that pre-reading of notes leading to an increase in the proportion of patients discharged from ENT clinics does not result in more discharges being premature or inappropriate.
Patient Satisfaction and Follow-up
- The 1994 study 2 reported that 12.5% of patients would have preferred another appointment and 7.5% were unhappy at being discharged.
- After 6 months, 14% of patients would have preferred ENT follow-up, and 26% of patients said they saw their GP within 6 months of discharge with symptoms related to their initial ENT complaint.
- General practitioners were happy to manage the patients themselves, and only one patient was seen again in the ENT department within 6 months.
Specific Conditions and Discharge Guidelines
- For acute sinusitis, a systematic review published in 2008 3 found that treatments such as antibiotics, antihistamines, decongestants, and topical corticosteroids can be effective in managing symptoms.
- A 2021 article 4 outlined the basic concepts and classifications of rhinosinusitis and provided best practices for clinical diagnoses and management strategies.
- A 2016 overview 5 of acute and chronic sinusitis in a primary care setting discussed complications and other indications for referral.
- A 2013 article 6 on acute sinusitis emphasized the importance of distinguishing between acute bacterial rhinosinusitis and other forms of rhinosinusitis, and provided guidance on treatment and management.