Reducing Admission for Anaphylaxis in a Pediatric Emergency Department Using a Clinical Decision Support Tool

Area of Science:

• Pediatric Emergency Medicine
• Clinical Quality Improvement
• Allergy and Immunology

Background:

• Anaphylaxis is a severe allergic reaction requiring prompt medical attention.
• Current guidelines for managing pediatric anaphylaxis lack clear indications for prolonged observation or hospitalization.
• This ambiguity can lead to unnecessary hospital admissions for low-risk patients.

Purpose of the Study:

• To implement a disposition-focused clinical decision support tool (CDST) in a pediatric emergency department (PED).
• To reduce the hospitalization rate for low-risk pediatric anaphylaxis patients from 49% to ≤12%.
• To evaluate the impact of the CDST on patient safety and healthcare costs.

Main Methods:

• A multidisciplinary team developed and implemented an evidence-based CDST for pediatric anaphylaxis management.
• The CDST stratified patients into low-risk and high-risk categories, recommending discharge for low-risk cases after a 4-hour observation.
• Data on hospitalization rates, 72-hour return visits, and emergency department length of stay were collected pre- and post-intervention.

Main Results:

• Hospitalization of low-risk pediatric anaphylaxis patients decreased significantly from 49% to 7% post-implementation (P < 0.0001).
• There was no significant increase in 72-hour return rates for anaphylaxis-related concerns among low-risk patients (P = 0.83).
• Median emergency department length of stay slightly increased, but the median cost per low-risk encounter decreased by $377 (P = 0.013).

Conclusions:

• An evidence-based, disposition-focused CDST effectively reduces hospitalizations for low-risk pediatric anaphylaxis.
• The implementation of the CDST improved patient safety by avoiding unnecessary admissions without increasing return visits.
• This quality improvement initiative resulted in significant cost savings for patient encounters.