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Improving Influenza Vaccination in the Pediatric Emergency Department
Courtney E Nelson1, Shannon Baumer-Mouradian2, Snezana Nena Osorio3
1From the Department of Pediatrics, Nemours Children's Health, Wilmington, Del.
Insights
Pediatric emergency departments can improve influenza vaccination rates through screening and electronic health record alerts. Initial success in screening and administration declined over time, highlighting the need for sustained interventions.
Area of Science:
- Pediatrics
- Public Health
- Infectious Disease Prevention
Background:
- Annual influenza vaccination is recommended for individuals 6 months and older by the American Academy of Pediatrics.
- A local pediatric emergency department (ED) faced lower-than-average influenza vaccination rates in 2019.
- The study addressed the need to enhance influenza vaccination coverage in a pediatric ED setting.
Purpose of the Study:
- To increase influenza vaccination screening from 53% to 95% within the pediatric ED.
- To improve influenza vaccine administration rates from 48% to 58% by March 2023.
- To evaluate an intervention model for influenza vaccination delivery in a pediatric emergency department.
Main Methods:
- The study included patients over 6 months old discharged from the ED, excluding those requiring resuscitation or transfer.
- Interventions involved implementing triage screening questions and electronic health record alerts.
- Data were collected over three influenza seasons, with a baseline and poststudy period, analyzed using Shewhart charts.
Main Results:
- Initial implementation achieved 98% screening and 70% vaccine administration in the first season.
- Screening rates decreased to 79-86% and immunization rates fell below baseline (37-50%) in subsequent seasons.
- Parental refusal rates remained stable, but provider discontinuation of vaccination increased over time.
Conclusions:
- An ED-based influenza vaccination delivery model can be effective with integrated triage screening.
- Consistent ordering by ED-based staff and effective EHR utilization are crucial for success.
- Sustained efforts are necessary to maintain high vaccination rates in pediatric emergency departments.
Introduction:
The American Academy of Pediatrics recommends annual influenza vaccination for patients aged 6 months or older. In 2019, our local pediatric emergency department (ED) vaccination rate was below the national average. We aimed to increase influenza vaccination screening from 53% to 95% and vaccine administration from 48% to 58% by March 2023.
Methods:
We included patients older than 6 months of age who were discharged from the ED, excluding those resuscitated or transferred from outside hospitals. Interventions included triage screening questions and electronic health record alerts to prompt vaccination. The baseline period was February-April 2020, with interventions during the next 3 influenza seasons, and a poststudy period from September 2023 to March 2024. Measures included vaccine administration (outcome), screening rate (process), provider discontinuation, family refusal, and discharge time (balancing). Data were analyzed using Shewhart charts (P and P').
Results:
We achieved nearly universal screening for vaccine eligibility (98%) and administered the vaccine to 70% of eligible patients during season 1 of implementation. Thereafter, the influenza screening rate dropped to 85% and 86% (seasons 2 and 3, respectively) and 79% (poststudy). Likewise, influenza immunization rates decreased below baseline in season 2 (37%) and remained low at 40% (season 3) and 50% (poststudy). There was no difference in parental refusal of the vaccine at the time of discharge; however, there was an increase in provider discontinuation from 1 consecutive season to the next.
Conclusions:
An ED-based influenza vaccine delivery model can be successful when the triage process includes screening, a consistent group of ED-based staff orders the vaccine, and there is effective use of the electronic health record.
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