2543. Implementation of a Fellow-Driven Β-Lactam Allergy De-Labeling Initiative on an Inpatient ID Consult Service

Abstract

BackgroundApproximately 10% of patients in the US report a penicillin (PCN) allergy, but more than 90% can safely receive β-lactam (BL) antibiotics. Having a reported BL allergy (BLA) is associated with increased length of stay, cost of care, adverse events, and mortality. As part of our institutional quality improvement incentive program for graduate medical trainees, the Infectious Diseases (ID) and Allergy/Immunology (AI) fellows implemented a protocol-driven approach to BLA evaluation. We sought to evaluate the success of this implementation.MethodsThis is a pre–post investigation of our BLA protocol. As an initial pilot phase prior to house-wide deployment, the ID and AI services implemented a BLA guideline incorporating thorough history-taking, graded challenge, and focused penicillin skin testing for patients on the ID consult service. All patients seen by the ID consult service from July 1, 2018 through June 30, 2019 with a documented BLA were included (baseline period April 1, 2018 through June 30, 2018). The primary endpoint was the proportion of patients meeting any one of the following: receipt of a BL, inpatient or outpatient referral to AI, or removal of BLA from the medical record by the time of discharge. Data were tracked quarterly and fed back to ID and AI fellows electronically. The Chi-square test was used to compare pre-post outcomes.ResultsOver the first three quarters, 258 patients with BLA were evaluated by the ID consult service. Our baseline compliance was 65%, which increased to an average of 81% over the subsequent three quarters (P = 0.003). Among patients with BLA seen by the ID consult service during the intervention, 177 (69%) received a BL, 37 (14%) underwent inpatient AI evaluation, 11 (4%) received discharge referrals to AI, and 126 (49%) had their BLA removed. Several patients met more than one primary endpoint.ConclusionImplementation of a protocol-driven BLA guideline by ID and AI fellows was feasible and led to an increase in the number of patients either receiving BLs in the hospital or undergoing timely evaluation or removal of BLA. In conclusion, the implementation of a β-lactam allergy de-labeling initiative is an effective way to empower trainees to incorporate BLA de-labeling into their practice.Disclosures All authors: No reported disclosures.