Reducing Emergency Department Observation Time for Patients with Low-Risk Anaphylaxis

Area of Science:

• Emergency Medicine
• Allergy and Immunology
• Quality Improvement Science

Background:

• Historically, anaphylaxis patients require 4-hour observation post-epinephrine to monitor for biphasic reactions.
• Updated 2020 guidelines suggest 1-hour observation for low-risk patients.
• Pediatric emergency departments face challenges in implementing shorter observation periods.

Purpose of the Study:

• To decrease pediatric emergency department observation time for low-risk anaphylaxis from 240 to 120 minutes within 9 months.
• To implement updated anaphylaxis guidelines into clinical practice.
• To assess the impact of reduced observation time on patient safety and return visits.

Main Methods:

• A multidisciplinary team identified barriers using a fishbone diagram.
• Interventions included education, EMR optimization, and feedback mechanisms.
• Statistical process control analyzed changes in observation time and return visits.

Main Results:

• Observation time for low-risk anaphylaxis decreased by 34% (79 minutes) in 5 months, sustained for 7 months.
• No change in observation time for high-risk patients.
• No missed biphasic anaphylactic reactions occurred during the intervention period.

Conclusions:

• Successfully reduced emergency department observation time for low-risk anaphylaxis.
• Achieved significant time reduction without compromising patient safety.
• Demonstrated feasibility of implementing guideline changes in a pediatric ED setting.