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Lessons Learned from a Quality Improvement Initiative to Increase COVID-19 Vaccination in Hospitalized Children
Daniel G Young1,2, Cortney S Rogers3, Isaac Mayefsky2
1From the Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
Insights
Pediatric coronavirus disease 2019 (COVID-19) vaccination rates remain low. A quality improvement initiative did not significantly increase COVID-19 vaccine uptake in hospitalized adolescents, highlighting the need for new strategies.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Quality improvement science
Background:
- Pediatric coronavirus disease 2019 (COVID-19) vaccination rates in the U.S. lag behind adult rates.
- Low vaccine acceptance and uptake in adolescents present a significant public health challenge.
- Hospitalized pediatric patients represent a critical population for targeted vaccination efforts.
Purpose of the Study:
- To implement a quality improvement (QI) initiative to double COVID-19 vaccination rates in hospitalized patients aged 12-21 years.
- To assess the effectiveness of existing interventions and gather feedback for future strategies to enhance pediatric COVID-19 vaccination.
- To evaluate the impact of interventions on vaccination documentation and patient length of stay.
Main Methods:
- A QI initiative was conducted in a freestanding children's hospital's inpatient units.
- Interventions included provider education, EMR alerts, parental counseling, and ensuring vaccine availability.
- Primary outcome was the percentage of hospitalized patients aged 12-21 receiving COVID-19 vaccine; process measures included provider documentation.
Main Results:
- COVID-19 vaccination rates increased 1.6-fold during the initial intervention phase but did not reach the target of 9.4%.
- Interrupted time series analysis showed no statistically significant impact of the QI initiative on vaccination rates.
- Documentation of COVID-19 vaccination increased significantly, while length of stay remained unchanged.
Conclusions:
- The implemented quality improvement initiative did not significantly increase COVID-19 vaccination rates in hospitalized adolescents.
- Lessons learned suggest nurse-driven protocols and annual integrated vaccination campaigns may improve uptake.
- Further research is needed to identify effective strategies for increasing pediatric COVID-19 vaccination.
Introduction:
Pediatric coronavirus disease 2019 (COVID-19) vaccination rates in the United States remain lower compared with adults. We aimed to (1) implement a quality improvement initiative to increase COVID-19 vaccination 2-fold in hospitalized patients 12-21 years of age from 4.7% during the baseline period (August 10, 2021-November 1, 2021) to 9.4% during the intervention phase (November 2, 2021-March 31, 2023) and (2) assess the importance of existing interventions and obtain feedback for future interventions to increase COVID-19 vaccination via a provider survey.
Methods:
We conducted the quality improvement initiative in the inpatient units of a freestanding children's hospital. Interventions included provider education, electronic medical record best practice alerts, monthly competition, parental counseling to increase vaccine acceptance, and ensuring vaccine availability. The primary outcome measure was the percentage of hospitalized patients 12-21 years of age who received COVID-19 vaccine. Providers addressing COVID-19 vaccination with patients, as documented by COVID-19-specific problem lists, were a process measure. Length of stay was a balancing measure.
Results:
Although COVID-19 vaccination increased 1.6-fold during the initial 5 months of interventions, the interrupted time series analysis did not show a significant impact of our interventions on vaccination. Documentation of COVID-19 vaccine-specific problem lists increased 1.9-fold during most of the intervention period. There was no significant (P = 0.61) difference in length of stay between children in the baseline and intervention groups.
Conclusions:
Despite our best efforts, we could not increase the number of COVID-19 vaccinations in our patients. Lessons learned suggest that creating a nurse-driven COVID-19 vaccine screening/ordering protocol and integrating COVID-19/influenza vaccination annually during influenza season can potentially increase vaccination rates, but further research is required.
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