Long-term success with the national health objective for influenza vaccination: an institution-wide model

To assess the long-term effectiveness of an influenza vaccination program.

725-bed university-affiliated VA teaching hospital providing care to over 35,000 outpatients.

500 randomly selected outpatients were surveyed following each immunization season using a validated, self-administered, postcard questionnaire.

The institution-wide program, designed to function automatically and to be independent of physician initiative, emphasizes organizational and patient-oriented educational strategies: 1) a hospital policy allowing nurses to vaccinate without a physician's order; 2) a walk-in flu shot clinic; 3) reminders on clinic progress notes; and 4) an educational mailing to all outpatients. The program was initiated in 1987 and has been maintained for each subsequent immunization season.

The response rate was over 75% for each of the four years in which there were two mailings. The response rate for 1988-1989, in which there were three mailings, was over 85%. Approximately 70% of the respondents were at high risk for influenza and its complications. Vaccination rates for these high-risk outpatients have been sustained at over 58% for each immunization season. The program is well received by the hospital staff and now functions on autopilot each year.

This highly successful institution-wide influenza vaccination program can be sustained long-term. Elements of this program may help others take advantage of opportunities for influenza prevention.