Avoidable emergency department visits for rabies vaccination.

Area of Science:

• Public Health
• Infectious Disease Management
• Healthcare Systems Analysis

Background:

• Subsequent rabies vaccine doses are not medical emergencies.
• Emergency department (ED) visits for rabies postexposure prophylaxis (PEP) were reviewed to identify avoidable visits for routine vaccination.

Purpose of the Study:

• To identify and quantify avoidable emergency department visits for rabies vaccination.
• To understand contributing factors to unnecessary ED utilization for rabies PEP.

Main Methods:

• Retrospective study of patients receiving human rabies immune globulin (HRIG) or rabies vaccine in 15 EDs from 2016-2018.
• Classification of ED visits as initial or non-initial healthcare encounters post-animal exposure.
• Categorization of non-initial visits as necessary or avoidable (rabies vaccination only).

Main Results:

• 19% of patients and 66% of non-initial ED visits were identified as avoidable for rabies vaccination.
• Suboptimal discharge instructions and difficulties coordinating outpatient follow-up were key factors.
• An estimated 7,500 to 33,600 avoidable ED visits for rabies vaccination occur annually in the US.

Conclusions:

• Approximately one in five patients receiving rabies PEP in the ED had avoidable follow-up visits for vaccination.
• Systemic issues in post-ED discharge coordination and access to outpatient rabies vaccine present significant challenges.
• Interventions are needed to streamline rabies PEP follow-up and reduce ED burden.