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Assessment of a COVID-19 vaccination protocol for unhoused patients in the emergency department
James S Ford1, Sam G Rouleau1, Jenny L Wagner2
1Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA.
Insights
Implementing emergency department-based Coronavirus Disease 2019 (COVID-19) vaccination for unhoused patients is feasible but yielded low vaccination numbers. Further research is needed to optimize this approach for vulnerable populations.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Services Research
Background:
- The Coronavirus Disease 2019 (COVID-19) pandemic necessitated innovative vaccination strategies.
- Unhoused populations face unique barriers to healthcare access, including vaccination.
- Emergency departments (EDs) present a potential setting for vaccinating underserved groups.
Purpose of the Study:
- To assess the feasibility of an ED-based COVID-19 vaccination protocol.
- To evaluate the implementation of a best practice alert (BPA) for vaccinating unhoused patients in the ED.
- To determine the number of unhoused patients vaccinated for COVID-19 within the ED setting.
Main Methods:
- A best practice alert (BPA) was implemented in the ED to prompt providers for COVID-19 vaccination orders for unhoused patients.
- Electronic medical record data were analyzed for patient encounters between June 10, 2021, and August 26, 2021.
- Descriptive statistics were used to report the number of unhoused patients and total vaccinations administered.
Main Results:
- During the study period, there were 1,474 encounters among 1,085 unique unhoused patients.
- The BPA fired in 71% of unhoused patient encounters but was accepted in only 8% of those instances.
- Forty-three unhoused patients were vaccinated via the BPA, with an additional 18 vaccinated without prompting, totaling 61 unhoused patients vaccinated in the ED.
Conclusions:
- An ED-based COVID-19 vaccination program for unhoused individuals is feasible.
- The current protocol resulted in a low number of vaccinations among the target population.
- Further investigation is required to enhance the effectiveness of EDs as vaccination sites for vulnerable populations.
Background:
We aimed to evaluate the feasibility of implementing an emergency department (ED)-based Coronavirus Disease of 2019 (COVID-19) vaccination protocol in a population of unhoused patients.
Methods:
On June 10, 2021, a best practice alert (BPA) was implemented that fired when an ED provider opened the charts of unhoused patients and prompted the provider to order COVID-19 vaccination for eligible patients. We downloaded electronic medical record data of patients who received a COVID-19 vaccine in the ED between June 10, 2021 and August 26, 2021. The outcomes of interest were the number of unhoused, and the total number of patients vaccinated for COVID-19 during the study period. Data were described with simple descriptive statistics.
Results:
There were 25,871 patient encounters in 19,992 unique patients (mean 1.3 visits/patient) in the emergency department during the study period. There were 1,474 (6% of total ED population) visits in 1,085 unique patients who were unhoused (mean 1.4 visits/patient). The BPA fired in 1,046 unhoused patient encounters (71% of PEH encounters) and was accepted in 79 (8%). Forty-three unhoused patients were vaccinated as a result of the BPA (4% of BPA fires) and 18 unhoused patients were vaccinated without BPA prompting. An additional 76 domiciled patients were vaccinated in the ED.
Conclusions:
Implementing an ED-based COVID-19 vaccination program is feasible, however, only a small number of patients underwent COVID-19 vaccination. Further studies are needed to explore the utility of using the ED as a setting for COVID-19 vaccination.
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