D3.285 - Improving Emergency Department Management of Adult Anaphylaxis: A Quality Improvement Initiative

The high-pressure environment of the Emergency Department (ED) may impact adherence to standardized guidelines for anaphylaxis management, including serum tryptase measurement and referrals to specialist allergy services. Ensuring consistent implementation of these guidelines is crucial for accurate diagnosis, appropriate follow-up, and long-term patient safety. This quality improvement project aimed to identify gaps in the ED management of anaphylaxis and implement interventions to standardize care, improve referral processes, and introduce the British Society for Allergy and Clinical Immunology (BSACI) Allergy Action Plan for Anaphylaxis to enhance patient education.

A retrospective audit was conducted of 89 adult patients admitted to the ED at University Hospitals Leicester with suspected anaphylaxis between January and June 2023. Compliance with two key recommended steps of National Institute for Health and Care Excellence (NICE) guidance was assessed: serum tryptase measurement during anaphylaxis episodes and referral to specialist allergy services for post-event assessment. Patient demographics, including age, gender, and ethnicity were recorded.

The age range was 17 to 79 years (mean: 40.4 years). Gender distribution showed a predominance of females (61%), and ethnicity data revealed that 33.33% were Asian-Indian, Bangladeshi, or Other, while 56.41% were White British.

Serum tryptase was measured in 65 patients (mean: 10 ± 12 μg/L). Among the whole group treated for anaphylaxis at the ED, 46 % of patients were not referred to a specialist allergy service at discharge. Compared to those who were not referred, gender distribution differed significantly among referred patients (p=0.008), with a higher proportion of females in the referred group (76% vs. 53%). However, no significant differences were observed in age, ethnicity, or mast cell tryptase levels.

This quality improvement project highlights possible gaps in anaphylaxis management within the ED and underscores the need for a standardized, efficient referral pathway to improve patient safety. By taking steps to implement a rapid referral process, integrating the BSACI Allergy Action Plan, and enhancing staff awareness, we aim to ensure that all patients with suspected anaphylaxis receive timely specialist input, structured patient education, and long-term management.