Reducing Hospitalization Rates for Children With Anaphylaxis.

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Clinical Practice Guidelines

Background:

• Most children with anaphylaxis in the emergency department (ED) are hospitalized.
• Opportunities exist to safely reduce unnecessary hospitalizations for pediatric anaphylaxis.
• A quality improvement (QI) intervention was implemented to improve care and reduce hospitalization rates.

Purpose of the Study:

• To implement and evaluate a QI initiative to reduce hospitalization rates for pediatric anaphylaxis.
• To assess the impact of evidence-based guidelines on ED hospitalization for anaphylaxis.
• To determine if reducing hospitalizations affected patient safety, measured by 72-hour ED revisits.

Main Methods:

• Utilized the Model for Improvement framework, implementing an evidence-based guideline in 2011.
• Supported guideline adoption and adherence through provider reminders and feedback.
• Analyzed hospitalization rates for 1169 pediatric anaphylaxis visits (2008-2014) using statistical process control, comparing with 34 other children's hospitals.

Main Results:

• The proportion of children hospitalized for anaphylaxis decreased from 54% to 36% after QI implementation.
• There was no increase in the 72-hour ED revisit rate.
• Hospitalization rates at 34 other US pediatric hospitals remained static at 52% during the study period.

Conclusions:

• A QI initiative, including evidence-based guidelines and provider feedback, safely reduced unnecessary hospitalizations for pediatric anaphylaxis.
• The observed reduction in hospitalizations was sustained for over 3 years.
• This approach offers a model for improving pediatric anaphylaxis care and reducing healthcare costs.