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Vaccinating in the Emergency Department, a Novel Approach to Improve Influenza Vaccination Rates via a Quality
Shannon H Baumer-Mouradian1,2, Abigail Kleinschmidt3,2, Ashley Servi3
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
Insights
Implementing a pediatric emergency department (ED) influenza vaccination program significantly increased vaccine administration. This initiative successfully vaccinated over 1,000 children, improving public health outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Public Health Interventions
- Vaccinology
Background:
- Annual influenza vaccination is recommended for children aged 6 months and older in the US.
- Current vaccination rates in children remain suboptimal, around 50% annually.
- Pediatric emergency departments (EDs) present an opportunity to improve influenza vaccine uptake.
Purpose of the Study:
- To implement and evaluate an influenza vaccination program in a pediatric ED.
- To increase influenza vaccine administration from a baseline of 75 to 1,000 doses.
- To assess the program's impact on vaccination rates, ED length of stay, and financial outcomes.
Main Methods:
- Process mapping was used to identify and address barriers to vaccination.
- Key interventions included mandatory screening, protocol development, staff education, and workflow optimization.
- Plan-do-study-act cycles were employed to test and refine interventions.
Main Results:
- The study included 33,311 children, with vaccine screening improving from 0% to 90%.
- 1,323 influenza vaccines were administered, exceeding the target of 1,000 doses.
- No significant changes in ED length of stay or hospital revenue were observed.
Conclusions:
- An efficient and cost-effective influenza vaccination program was successfully implemented in a pediatric ED.
- The program significantly increased influenza vaccine administration in a population that may otherwise be unvaccinated.
- This model demonstrates a viable strategy for enhancing pediatric vaccination rates in emergency settings.
Introduction:
Annual influenza vaccination is recommended for all US children 6 months and older to prevent morbidity and mortality. Despite these recommendations, only ~50% of US children are vaccinated annually. Influenza vaccine administration in the pediatric emergency department (ED) is an innovative solution to improve vaccination rates. However, during the 2017-2018 influenza season, only 75 influenza vaccinations were given in this tertiary care ED. We aimed to increase the number of influenza vaccines administered to ED patients from 75 to 1,000 between August 2018 and March 2019.s.
Methods:
Process mapping identified potential barriers and solutions. Key interventions included mandatory vaccine screening, creation of a vaccine administration protocol, education for family, provider, and nursing, a revised pharmacy workflow, and weekly staff feedback. Interventions were tested using plan-do-study-act cycles. The process measure was the percent of patients screened for vaccine status. The primary outcome was the number of influenza vaccines administered. The balancing measures were ED length of stay (LOS), wasted vaccines, and financial impact on the institution.
Results:
We included 33,311 children in this study. Screening for vaccine status improved from 0% to 90%. Of those screened, 58% were eligible for vaccination, and 8.5% of eligible patients were vaccinated in the ED. In total, 1,323 vaccines were administered with no significant change in ED LOS (139 min) and no lost revenue to the hospital.
Conclusions:
We implemented an efficient, cost-effective, influenza vaccination program in the pediatric ED and successfully increased vaccinations in a population that might not otherwise receive the vaccine.
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