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Emergency departments: An underutilized resource to address pediatric influenza vaccine coverage
Rebecca Hart1, Yana Feygin1, Theresa Kluthe1
1Department of Pediatrics, Norton Children's and the University of Louisville School of Medicine, 571 S. Floyd Street, Suite 412, Louisville, KY 40202, United Sates.
Insights
Pediatric emergency departments (EDs) rarely offer influenza vaccines (IV). Implementing IV programs in EDs can significantly increase vaccination rates for children, particularly underserved populations.
Area of Science:
- Pediatric emergency medicine
- Public health interventions
- Vaccination programs
Background:
- Emergency department (ED) based influenza vaccine (IV) programs are effective in adults.
- Limited data exists on the prevalence, feasibility, and implementation of pediatric ED IV programs.
Purpose of the Study:
- To determine the reach and effectiveness of IV practices in pediatric EDs.
- To identify facilitators and barriers to pediatric IV administration in ED settings.
Main Methods:
- Cross-sectional survey of pediatric ED physicians regarding IV programs.
- Assessment of EDs offering IV, annual vaccine administration, and perceived facilitators/barriers.
- Statistical comparison of facilitators and barriers between high, low, and non-vaccinating EDs.
Main Results:
- Only 44.3% of surveyed EDs offer influenza vaccines (IV) annually.
- High/model performers utilized established workflows more frequently than lower performers.
- Key facilitators include provider/administration buy-in, EHR integration, and leadership support.
Conclusions:
- Over half of participating pediatric EDs do not offer influenza vaccines (IV).
- Addressing identified barriers and leveraging facilitators can enhance pediatric IV program implementation.
- Expanding ED IV programs has the potential to improve vaccination rates, especially in minority and underserved children.
Background:
Emergency department (ED) based influenza vaccine (IV) programs have been successful in adults; however, little is known about pediatric ED IV programs in terms of prevalence, feasibility, or successful implementation.
Aims:
To describe the reach and effectiveness of IV practices in pediatric EDs, and identify IV facilitators and barriers.
Methods:
We assessed, via cross-sectional survey of pediatric ED physicians, number of EDs offering IV to children, vaccines administered annually, and perceived facilitators/barriers to vaccination. The proportion of EDs offering IV is reported. Chi-square tests compared facilitators and barriers among high performers (≥50 IV/year), low performers (<50 IV/yr), and non-vaccinators. We calculated an area of missed effect for the number of children who could be vaccinated if non-vaccinating EDs offered IV.
Results:
Among 492 physicians from 166 EDs, 142 responded (representing 61 (37.3 %) EDs). Most EDs were in large, urban, academic, freestanding children's hospitals (Table 1). Only twenty-six EDs (44.3 %) offer ≥ 1 IV/yr. Seventeen (65.4 %) were low performers, five (19.2 %) high performers, and four (15.4 %) were model programs. High/model performers used establish workflows more commonly than lower performers (78 % vs. 33 %), although this was not statistically significant (p = 0.077). Common facilitators included: strong provider and administration buy-in, electronic health record facilitation, storage/accessibility, and having a leadership team/champion (Fig. 1). Non-vaccinators commonly perceived lack of these factors as barriers. Many (24/61, 39.3 %) EDs expressed interested in establishing or growing IV programs. Up to 18,250 unvaccinated children could receive IV annually if non-vaccinating EDs offered IV during influenza season.
Conclusions:
Over half of EDs participating in the Pediatric Emergency Medicine Collaborative Research Committee do not currently offer pediatric IV. Addressing identified barriers/facilitators to develop IV programs in EDs has potential to improve vaccination rates, especially among minority and underserved children.
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