Institution of Clinic Scheduling Guidelines for Early Introduction of Peanut

Abstract

The National Institute of Allergy and Infectious Disease (NIAID) published international consensus addendum guidelines on the early introduction of peanuts. One criticism of these guidelines is the shortage of allergists in the USA may prevent the practical institution of these guidelines. We designed a scheduling protocol to prioritize infants at high risk for peanut allergy. We flagged every referral for patients <12 months old as urgent, regardless of reason. Four new patient appointments and two challenge slots were reserved weekly for these patients. If appointment was not available within two weeks a physician would review case to assess urgency. Evaluation and treatment was at the discretion of treating physician. We took a retrospective review July 2016-September 2018. 69 patients met criteria as “high risk” per NIAID guidelines and were evaluated in clinic on average 18.9 days (range 2-62 days) post referral. 31 patients were determined to need an in office peanut challenge for peanut introduction, with challenges happening on average 31.7 days (range 7-56 days) post referral. During this time period the 3rd next new patient slot for non-urgent appointments was on average 94.3 days. By automatically flagging new referrals in all children <12 months old and reserving clinic and challenge appointments for these children, we were able to systematically evaluate these children 75.4 days sooner than general referrals. Our unique scheduling method allowed us to prioritize patients at high risk for peanut allergy and helped decrease the risk of developing a peanut allergy while on the appointment wait list.