Farbman Karen S, Michelson Kenneth A, Neuman Mark I, Dribin Timothy E, Schneider Lynda C, Stack Anne M
Divisions of Emergency Medicine and
Divisions of Emergency Medicine and.
Pediatrics. 2017 Jun;139(6). doi: 10.1542/peds.2016-4114.
Most children with anaphylaxis in the emergency department (ED) are hospitalized. Opportunities exist to safely reduce the hospitalization rate for children with anaphylaxis by decreasing unnecessary hospitalizations. A quality improvement (QI) intervention was conducted to improve care and reduce hospitalization rates for children with anaphylaxis.
We used the Model for Improvement and began with development and implementation in 2011 of a locally developed evidence-based guideline based on national recommendations for the management of anaphylaxis. Guideline adoption and adherence were supported by interval reminders and feedback to providers. Patients from 2008 to 2014 diagnosed with anaphylaxis were identified, and statistical process control methods were used to evaluate change in hospitalization rates over time. The balancing measure was any return visit to the ED within 72 hours. To control for secular trends, hospitalization rates for anaphylaxis at 34 US children's hospitals over the same time period were analyzed.
Over the study period, there were 1169 visits for children with anaphylaxis, of which 731 (62%) occurred after the QI implementation. The proportion of children hospitalized decreased from 54% to 36%, with no increase in the 72-hour ED revisit rate. The hospitalization rate across 34 other US pediatric hospitals remained static at 52% over the study period.
We safely reduced unnecessary hospitalizations for children with anaphylaxis and sustained the change over 3 years by using a QI initiative that included evidence-based guideline development and implementation, reinforced by provider reminders and structured feedback.
大多数在急诊科发生过敏反应的儿童需要住院治疗。通过减少不必要的住院治疗，存在安全降低过敏反应儿童住院率的机会。开展了一项质量改进（QI）干预措施，以改善护理并降低过敏反应儿童的住院率。
我们采用了改进模型，并于2011年开始制定和实施基于国家过敏反应管理建议的本地循证指南。通过定期提醒和向医疗服务提供者反馈来支持指南的采用和遵守情况。确定了2008年至2014年诊断为过敏反应的患者，并使用统计过程控制方法来评估住院率随时间的变化。平衡指标是在72小时内再次前往急诊科就诊。为了控制长期趋势，分析了同期美国34家儿童医院过敏反应的住院率。
在研究期间，有1169例儿童因过敏反应就诊，其中731例（62%）发生在质量改进措施实施之后。住院儿童的比例从54%降至36%，72小时内再次前往急诊科就诊的比例没有增加。在研究期间，美国其他34家儿科医院的住院率保持在52%不变。
我们通过一项质量改进举措安全地减少了过敏反应儿童的不必要住院治疗，并在3年内维持了这一变化，该举措包括循证指南的制定和实施，并通过向医疗服务提供者提醒和结构化反馈加以强化。
