Characterization of Emergency Department Rabies Post-Exposure Prophylaxis Procedures with an Infectious Diseases...

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Rabies post-exposure prophylaxis (rPEP) administered in emergency departments (EDs) is costly and logistically complex.
• The time-sensitive nature of rPEP often necessitates multiple ED visits for vaccine administration, increasing patient burden and healthcare expenses.

Purpose of the Study:

• To evaluate the effectiveness of referring patients to an Infectious Diseases (ID) Clinic for rPEP.
• To characterize vaccine administration redirection, guideline adherence, and identify areas for process improvement.

Main Methods:

• A retrospective chart review was conducted on adult and pediatric patients who received rabies immunoglobulin in the ED between 2016 and 2019.
• Data analysis focused on referral rates to the ID Clinic, number of ED visits for vaccination, and vaccination completion status.

Main Results:

• Of 89 patients, 66.3% were referred to the ID Clinic, resulting in significantly fewer ED visits for repeat vaccinations (P < .001).
• Of 177 prescribed vaccinations, 105 were administered in the ID Clinic, avoiding 105 ED visits.
• Having health insurance significantly increased the likelihood of completing the vaccination series (OR = 4.34) and receiving follow-up doses in the clinic.

Conclusions:

• Referral to an ID Clinic streamlines rPEP administration, substantially reducing ED utilization.
• Insurance status is a critical determinant for both accessing ID Clinic services and completing the rPEP vaccination series.
• Future strategies should focus on integrated care models, support for uninsured patients, and improving vaccination completion rates.