ED intervention reduces pediatric anaphylaxis-related admissions
BALTIMORE — An ED quality improvement intervention, which included implementation of evidence-based guidelines, helped to reduce hospitalization rates among children who presented with anaphylaxis by 33%, according to recent research presented at the Pediatric Academic Societies Meeting.
“Our quality improvement initiative had as its primary aim to reduce admissions of patients with anaphylaxis by 25% after our 2011 introduction of an Evidence-Based Guideline of Emergency Department management of anaphylaxis,” Karen S. Farbman, MD, MPH, of the division of emergency medicine at Boston Children’s Hospital, told Infectious Diseases in Children. “We sought to monitor all low-risk patients in the ED for at least 4 hours prior to discharge and then to discharge patients home. We also sought to teach all patients the use of an epinephrine auto-injector prior to discharge.”
Karen S. Farbman
The researchers implemented the intervention that included the development of evidence-based guidelines for standardizing care and discharge of patients with anaphylaxis or allergic reaction. The intervention also provided reminders and feedback to physicians to help reinforce guideline adherence. To assess the intervention’s effectiveness, the researchers identified 1,169 children who presented with anaphylaxis or allergic reaction and also received epinephrine in the ED between 2008 and 2014. Statistical analysis was used to determine the associations with the intervention and changes in hospitalization rates.
Study results showed that the quality improvement reduced anaphylaxis-related hospitalizations from 54% before implementation to 36% after initiation. The researchers noted there also was no increase in the 72-hour ED revisit rate after implementation of the initiative.
“Discharging low-risk patients from the ED after treatment for anaphylaxis can become routine,” Farbman said. “Looking forward, we expect the next iteration of the guideline will allow for discharge of medium-risk patients as well, reserving hospital admission only for those patients who fall into a high-risk category.” – by David Costill
Farbman KS, et al. Abstract 1230.4. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.