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Reducing Admission for Anaphylaxis in a Pediatric Emergency Department Using a Clinical Decision Support Tool.
Wolpert, Katherine H; Kestle, Rebecca; Weaver, Nicholas; Huynh, Kelly; Yoo, Minkyoung; Nelson, Richard; Lane, Roni D.
Afiliación
  • Wolpert KH; From the Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash.
  • Kestle R; Division of Pediatric Emergency Medicine, Department of Pediatrics, Salt Lake City, Utah.
  • Weaver N; Division of Pediatric Emergency Medicine, Department of Pediatrics, Salt Lake City, Utah.
  • Huynh K; Department of Pediatrics, Salt Lake City, Utah.
  • Yoo M; Department of Economics, University of Utah, Salt Lake City, Utah.
  • Nelson R; Division of Epidemiology, University of Utah, Salt Lake City, Utah.
  • Lane RD; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Pediatr Qual Saf ; 7(5): e590, 2022.
Article en En | MEDLINE | ID: mdl-38584955
ABSTRACT

Introduction:

Anaphylaxis is a life-threatening condition necessitating emergent management. However, the benefits of prolonged observation and indications for hospitalization are not well established. Through the implementation of a disposition-focused clinical decision support tool (CDST), this quality improvement initiative aimed to reduce hospitalization for low-risk patients presenting to the pediatric emergency department (PED) with anaphylaxis from 49% to ≤12% within 12 months of implementation.

Methods:

The intervention included patients 18 years and younger of age presenting with anaphylaxis to the PED. A multidisciplinary team identified a 2006 evidence-based guideline as a significant contributor to hospitalization. The updated guideline incorporated a disposition-focused CDST that stratified patients as low-risk or high-risk and recommended discharge of low-risk patients after a 4-hour observation period. The primary outcome measure was the percentage of low-risk patients hospitalized. Balancing measures included low-risk patient 72-hour return rate and PED length of stay for all comers. Secondary outcomes included a focused cost analysis.

Results:

Fifty-three children preintervention and 43 children postintervention presenting with anaphylaxis met low-risk criteria. Postimplementation, hospitalization of low-risk patients decreased from 49% to 7% (P < 0.0001). No low-risk patients returned in 72 hours for an anaphylaxis-related concern (P = 0.83). The median PED length of stay increased from 189 to 193 minutes (P < 0.0001). The median cost per low-risk encounter decreased by $377 (P = 0.013).

Conclusions:

After implementing an evidence-based disposition-focused CDST, hospitalization of low-risk patients presenting to the PED with anaphylaxis significantly decreased without an increase in 72-hour returns. In addition, patient encounters demonstrated cost savings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Qual Saf Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pediatr Qual Saf Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos