A Quality Improvement Initiative to Increase Referrals to an Early Peanut Introduction Clinic

RATIONALE: New guidelines recommend introducing peanut to all infants prior to 12 months of age in an effort to prevent the development of allergy. Peanut allergy testing is recommended for high risk infants but timely access to allergists may not be available for all. When indicated, it may be logistically difficult to perform supervised feedings during routine clinic appointments.

METHODS: In an effort to provide timely access to allergy evaluation within a tertiary care pediatric academic center, the Early Peanut Introduction Clinic (EPIC) was established in September, 2016. EPIC is staffed by 2 allergists per session and can accommodate 8 patients during a dedicated one half-day session each month. Skin prick testing and depending upon results, supervised peanut introduction are offered.

RESULTS: EPIC had only one new patient referral during the first 6 months. A quality improvement (QI) project was developed to increase the percentage of filled EPIC appointments per month from 0% to 50% within 6 months. Using QI methodology and multiple Plan-Do-Study-Act cycles, several interventions were developed, including: implementation of an electronic referral, education/outreach to primary care physicians and dermatologists, and development of educational materials for placement in referring physician offices.

One month after QI initiatives began, 25% of EPIC appointment slots were filled, followed by an increase to 50% by month 4, 75% by month 5, and 63% by month 6.

CONCLUSIONS: Use of QI methodology increased referrals to a clinic established to assist new guideline implementation for early introduction of peanut, which requires timely access to allergy evaluation.