Lessons Learned from a Quality Improvement Initiative to Increase COVID-19 Vaccination in Hospitalized Children

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.