Pediatric Hospital Medicine Fellow UCLA Mattel Children's Hospital Walnut Creek, California, United States
Background: Pediatric anaphylaxis is often under-diagnosed and under-treated in the emergency setting. Previous quality improvement projects have sought to improve aspects of anaphylaxis management but there has yet to be a published study that evaluates whether a quality improvement project can improve the identification and treatment of anaphylaxis in the emergency department. Objective: Our objective is to evaluate whether a quality improvement project can improve the diagnosis, timely administration of epinephrine, and epinephrine auto-injector prescription upon discharge in pediatric patients who present with anaphylaxis in the emergency setting. Design/Methods: We conducted a baseline retrospective chart review of pediatric patients up to age 21 who presented with allergy-related symptoms to our institution from 2019 to 2021. Our outcome measures are the percentage of patients meeting anaphylaxis criteria as defined by NIAID/FAAN guidelines who received epinephrine, timing of epinephrine administration, and percentage of patients discharged with a prescription for epinephrine. Given our project falls under the goal of improving internal care, our IRB deemed it did not require review or approval. Thus far, of those patients who met criteria for anaphylaxis in the emergency room, 52% (73/140) received epinephrine. The average length of time for epinephrine to be administered was 15 minutes. 75% (168/224) of patients who met criteria for anaphylaxis, either at home or in the emergency room, received an epinephrine prescription on discharge. We also performed chi-square tests to determine the associations between certain patient characteristics and epinephrine administration. Our next step is to implement our interventions: a revised order set, pathway, and provider education, which is currently ongoing. We will then evaluate the impact of our interventions by performing additional chart review, assessing our outcome measures 3 months after their implementation as part of our first PDSA cycle, which is tentatively scheduled for February 2024.
