Effect of a Computerized Alert on Emergency Department Hepatitis A Vaccination in Homeless Patients During a Large Regional Outbreak

Castillo, Edward M.; Chan, Theodore C.; Tolia, Vaishal; Trumm, Nicholas A.; Powell, Richard R.; Brennan, Jesse J.; Kreshak, Allyson A.

doi:10.1016/j.jemermed.2018.09.004

Cited by 18 publications

(39 citation statements)

References 7 publications

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“…Healthcare systems provided nearly half of the vaccinations administered in San Diego County. Although 75% of vaccinations administered at UCSDH were delivered at ambulatory clinics, and similar efforts occurred in other outpatient clinics in San Diego (16), proactive vaccination administration in EDs and urgent care settings or during inpatient hospitalizations with real-time access to analytics and clinical informatics support were crucial given that highest-risk population most likely had limited access to routine outpatient care (8,17). Data are sparse on the use of acute care inpatient facilities as a setting for an aggressive outbreakcontrol vaccination program.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, ED-based vaccination programs for pneumococcus and influenza have proven successful (19)(20)(21). Because EDs and urgent care may be the sole contact of a disenfranchised population with the medical system, data on EDs partnering with public health departments to administer outbreak-control vaccinations have increased (8,17,22).…”

Section: Discussionmentioning

confidence: 99%

“…As healthcare systems become an important site for vaccination administration, optimizing EHR support tools is crucial in increasing vaccination rates. Previous efforts focused on EDs only, but for this response, UCSDH implemented EHR-based alerts across the continuum of care to achieve higher vaccination rates (8). Although the direct effects of the alerts cannot be measured, vaccination of the homeless population peaked in August 2017 when the EDfocused alert was first implemented, whereas vaccination of other at-risk populations peaked in October 2017, when the second BPA alert with the wider range of risk factors was implemented across all care settings.…”

Section: Discussionmentioning

confidence: 99%

“…epic.com), was constructed to flag the charts of selfidentified homeless patients starting August 1, 2017. This BPA prompted providers to order the hepatitis A vaccine as described in Castillo et al (8). From June 2017 through full implementation of the intervention in homeless persons in October 2017, these efforts were expanded with a second BPA, designed to identify patients with >1 of the following risk factors: homelessness, illicit drug use, alcohol abuse, cirrhosis, hepatitis B infection, and hepatitis C infection.…”

Section: Vaccinationmentioning

confidence: 99%

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Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018

Kang

Horman

Taplitz

et al. 2020

Emerg. Infect. Dis.

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H epatitis A virus (HAV) is transmitted through the fecal-oral route either by person-to-person contact or by ingestion of contaminated food or water (1). With the availability of the hepatitis A vaccine in 1995 and the routine vaccination of children in highincidence states (including California) since 1999 and nationally since 2006, the incidence of HAV infection has declined dramatically in the United States (2,3). Hepatitis A vaccine is highly effective; it has a sero-conversion rate of ≈100% (4). Nevertheless, despite the substantial decline in HAV infection, sporadic cases and outbreaks continue to occur. During 2016-2018, San Diego County, California, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades (5). This outbreak was characterized by hepatitis A spread through person-to-person contact among persons experiencing unstable housing situations with or without illicit drug use (5). Since 2017, similar outbreaks have been reported in 25 states; some of the index cases in those outbreaks were linked to San Diego. As of November 1, 2019, a total of 27,634 cases, 16,679 hospitalizations, and 275 deaths have been recorded in the United States (6). The public health response to the outbreak in San Diego focused on a 3-pronged strategy to vaccinate, sanitize, and educate (7). Local health systems, including University of California San Diego Health (UCSDH), closely and proactively collaborated with San Diego County Public Health (SDCPH) to participate in the outbreak control initiatives. We report the public health contribution of the academic medical center through the implementation of hospital-level prevention and outbreak management activities. Methods Study Setting Our study was a retrospective review of hepatitis A diagnoses and vaccinations administered by SD-CPH and UCSDH. SDCPH first declared a hepatitis A outbreak on March 8, 2017, and traced the first case to November 22, 2016 (Figure 1). The outbreak control vaccination initiatives began on March 10,

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Vaccinationmentioning

confidence: 99%

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Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018

Kang

Horman

Taplitz

et al. 2020

Emerg. Infect. Dis.

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“…A recent study from the 2018 San Diego outbreak showed that utilization of a BPA within the electronic health record (EHR) helped identify high-risk patients and remind providers of vaccine availability, leading to an overall 77% vaccination rate of their target population. 5 The Centers for Disease Control and Prevention recommends administering two doses of the vaccine, six months apart. However, a single dosage is up to 98% effective at preventing transmission, which is optimal for patients without primary care physician follow-up who present to the ED.…”

Section: Ed-based Hepatitis a Vaccination Program In Response To An Omentioning

confidence: 99%

Emergency Department-based Hepatitis A Vaccination Program in Response to an Outbreak

Kaigh

Blome

Schreyer

et al. 2020

WestJEM

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(PDPH) declared a public health emergency due to hepatitis A in August 2019. 1 Our emergency department (ED) serves a population with many of the identified risk factors for hepatitis A transmission. This study examines the impact of an ED-based hepatitis A vaccination program, developed in partnership with the PDPH, on incidence of hepatitis A infection and hospital admission. Methods: We conducted a retrospective review of all ED visits in the 12-week period centered around the implementation of the ED-based hepatitis A vaccination program. All adult patients presenting to the ED were offered vaccination, with vaccines supplied free of charge by the PDPH. We compared the incidence of diagnosis and of hospital admission for treatment of hepatitis A before and after implementation of the program. Results: There were 10,033 total ED visits during the study period, with 5009 of them prior to the implementation of the vaccination program and 5024 after implementation. During the study period, 669 vaccines were administered. Before the vaccination program began, 73 patients were diagnosed with hepatitis A, of whom 67 were admitted. After implementation of the program, 38 patients were diagnosed with hepatitis A, of whom 31 were admitted. Conclusion: A partnership between an ED and the local public health department resulted in the vaccination of 669 patients in six weeks in the midst of an outbreak of a vaccine-preventable illness, with a corresponding drop in ED visits and hospital admission for acute hepatitis A.

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Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings

et al. 2022

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BACKGROUND: Naloxone is a li fe-saving, yet underprescribed, medication that is recommended to be provided to patients at high risk of opioid overdose. OBJECTIVE: We set out to evaluate the changes in prescriber practices due to the use of an electronic health record (EHR) advisory that prompted opioid prescribers to co-prescribe naloxone when prescribing a high-dose opioid. It also provided prescribers with guidance on decreasing opioid doses for safety. DESIGN: This was a retrospective chart abstraction study looking at all opioid prescriptions and all naloxone prescriptions written as emergency department (ED) discharge, inpatient hospital discharge, or outpatient medi-

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Effect of a Computerized Alert on Emergency Department Hepatitis A Vaccination in Homeless Patients During a Large Regional Outbreak

Cited by 18 publications

References 7 publications

Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018

Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018

Emergency Department-based Hepatitis A Vaccination Program in Response to an Outbreak

Electronic Advisories Increase Naloxone Prescribing Across Health Care Settings

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