A Quality Improvement Initiative to Increase Access to Oral Food Challenges

Oral food challenges (OFCs) are the gold standard method to confirm food allergy (FA). However, OFCs are resource intensive and carry inherent risk of anaphylaxis, making it difficult to accommodate the demand for resources in clinical practice. We used a quality improvement (QI) approach to increase the number of OFCs offered in an outpatient allergy clinic associated with a tertiary care pediatric medical center. Our aim was to increase the number of OFCs without requesting additional resources, such as clinic space or personnel, from a baseline of 30 OFC to 45 OFC each month. We created a key driver diagram to highlight potential areas for improvement and then completed multiple plan-do-study-act cycles focused on scheduling, communication with families, addressing cancellations and maintaining an active waiting list. We observed a base line shift from a mean of 30 OFC/month to 41 OFC/month after initiating reminder patient calls in August 2018. The number of OFC continued to climb with additional interventions, such as removing medication challenges from OFC spots, centralizing OFC scheduling and implementing a protocol to allow low risk OFCs at off site locations. There was a mean of 54 OFC/month between March – July 2019. Availability of timely OFC is an important part of successful FA management. However, because OFCs are difficult to perform in a busy clinic, there is often a delay in providing this important service. Through a QI methodology, we were able to increase the number of OFC offered in clinic without utilizing additional resources.