D2.340 - Improving Post-Anaphylaxis Referral Pathways in the Emergency Department: A Quality Improvement Initiative

Guidelines recommend that all patients treated for anaphylaxis in the emergency department (ED) are referred to specialist allergy services for investigation, education, and prevention of recurrent reactions. However, adherence to post-anaphylaxis referral pathways remains inconsistent, placing patients at risk of recurrent, potentially life-threatening reactions. This quality improvement initiative aimed to identify gaps in ED management of adult anaphylaxis and to evaluate whether targeted educational and technological interventions could improve referral to specialist allergy services.

An initial retrospective audit reviewed adult ED attendances coded as anaphylaxis between January and June 2023 at a UK tertiary centre. Compliance with guideline-recommended care was assessed, focusing on serum tryptase measurement and referral to specialist allergy services. Patient demographics were recorded. Following identification of deficiencies, quality improvement interventions were implemented, including dissemination of findings at ED governance meetings, updates to ED anaphylaxis educational resources (Figure 1), and migration of allergy referrals to an electronic referral system. A re-audit was subsequently performed over a three-month period.

In the initial audit, 89 patients were identified, with a mean age of 40.4 years, a predominance of females (61%), and the majority being White British (56.4%). Serum tryptase was measured in 65 patients (73%), with a mean value of 10 ± 12 μg/L. Forty-six percent of patients were not referred to specialist allergy services at discharge.

Following the quality improvement interventions, 39 adult patients were included in the re-audit, with a mean age of 41 years. Serum tryptase was measured in 32 patients (82%), with a mean value of 8.8 ± 6.9 μg/L. Only 7 patients (18%) were not referred to the allergy service at discharge, representing a substantial improvement in referral rates compared with the initial audit. The re-audit cohort demonstrated comparable age and ethnicity distribution to the initial audit, with a slight male predominance (57.5%).

This quality improvement initiative demonstrates that targeted education combined with electronic referral pathways can significantly improve adherence to guideline-recommended post-anaphylaxis care. Streamlining referral processes through technology, alongside staff education, represents an effective and sustainable strategy to enhance patient safety and long-term outcomes following anaphylaxis.