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Improving Care at Emergency Department Discharge for Pediatric Patients with Anaphylaxis Using a Quality Improvement
Chisom Agbim1,2, Marci Fornari3,4, Emily Willner3,4
1From the Emergency Department, Children's Hospital Colorado, Aurora, CO.
Insights
Pediatric anaphylaxis care improved with enhanced discharge planning, including action plans and allergy referrals. This quality improvement initiative addressed variability in emergency department care for children experiencing severe allergic reactions.
Area of Science:
- Pediatric Emergency Medicine
- Quality Improvement Science
- Allergy and Immunology
Background:
- Anaphylaxis requires prompt recognition and treatment, yet pediatric patients often receive incomplete emergency department (ED) discharge care.
- Wide variability in discharge planning for pediatric anaphylaxis was observed at our institution.
Purpose of the Study:
- To improve ED discharge care for pediatric patients diagnosed with anaphylaxis using a quality improvement framework.
- Specific aims included increasing anaphylaxis action plan distribution and allergy clinic referrals.
Main Methods:
- Interventions involved electronic health record (EHR) system revisions, interdisciplinary partnerships, and provider education.
- Outcome measures focused on anaphylaxis action plan receipt and allergy clinic follow-up rates.
- Emergency department length of stay was monitored as a balancing measure.
Main Results:
- Anaphylaxis action plan distribution increased from 0% to 34%.
- Allergy clinic referral rates improved from 61% to 82%.
- The average ED length of stay remained stable at 347 minutes.
Conclusions:
- Revising discharge instructions and implementing educational interventions significantly improved anaphylaxis discharge care.
- Future efforts will leverage EHR modifications to enhance care in other clinical settings.
Introduction:
Anaphylaxis is a potentially fatal systemic reaction that requires prompt recognition and targeted treatment. Despite international consensus and national guidelines, there is often incomplete care for pediatric patients discharged from the emergency department (ED) with a diagnosis of anaphylaxis. Our institution experienced wide variability in discharge planning for patients with anaphylaxis. The goal of our study was to improve care at ED discharge for pediatric patients with anaphylaxis using a quality improvement framework. The specific aims were to increase the frequency of patients diagnosed with anaphylaxis who receive an anaphylaxis action plan at ED discharge from 0% to 60% and to increase referrals to an allergy clinic from a baseline of 61%-80% between October 2020 and April 2021.
Methods:
Targeted interventions included revisions to the electronic health record system, forging interdisciplinary partnerships and emphasizing provider education. Outcome measures were the proportion of patients receiving an anaphylaxis action plan and an allergy clinic follow-up. The balancing measure was the ED length of stay.
Results:
The study showed an increase in anaphylaxis action plans from 0% to 34%. Allergy clinic referral rates improved from 61% to 82% within the same period. The average length of stay of 347 minutes remained unchanged.
Conclusions:
Revising the discharge instructions to include an anaphylaxis action plan and reinforcing provider behaviors with educational interventions led to an overall improvement in discharge care for patients with anaphylaxis. Future work will focus on electronic health record changes to continue progress in additional clinical settings.
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