Vaccinating in the Emergency Department, a Model to Overcome Influenza Vaccine Hesitancy

Abstract

Introduction: Vaccine hesitancy and delays in vaccine administration time have limited the success of prior influenza vaccination initiatives in the pediatric emergency department (ED). In 2018–2019, season 1, this ED implemented mandatory vaccine screening and offered the vaccine to all eligible patients; however, only 9% of the eligible population received the vaccine. In 2019–2020, season 2, the team sought to improve influenza vaccination rates from 9% to 15% and administer over 2,000 vaccines to eligible ED patients. Methods: Key drivers included: identifying vaccine hesitancy, providing counseling, reducing administration delays, and developing reminders for vaccine administration. We tested interventions using plan-do-study-act cycles. We included discharged ED patients, age 6 months–18 years old, emergency severity index score 2–5, and no prior vaccine this season. Process measures included percent of patients screened, eligible, accepting the vaccine, and leaving before vaccination. Outcome measures were the percent of eligible patients vaccinated and the total number of vaccines administered. Vaccination time was the balancing measure. Results: We included 57,804 children in this study. Comparing season 1 to 2, screening rates (84%) and eligibility rates (58%) were similar. Vaccine acceptance rates improved from 13% to 22%, the proportion of patients leaving before vaccination decreased from 32% to 17%, and vaccination rates improved from 9% to 20%. Total vaccines administered increased from 1,309 to 3,180, and vaccination time was 5 minutes faster in season 2. Conclusions: This ED influenza vaccination process provides a model to overcome vaccine hesitancy and can be adapted and replicated for any vaccine-preventable illness.

Emergency Departments: An Underutilized Resource for Expanding COVID-19 Vaccine Coverage in Children

“…Questions included information about the respondent and their primary ED (including the respondent’s role, the ED’s annual volume, location, and the proportion of patients receiving government insurance), whether the ED offers CVs, and how many vaccines were administered in the past year. Facilitators and barriers were assessed via the question: “Which of the following do you perceive to be [facilitators/barriers] of COVID-19 vaccination to children in your ED?” using a 5-point Likert scale and a list of potential facilitators and barriers, which were selected based on the prior literature as well as a priori by the investigators and their prior research in this area [ 26 , 35 , 39 , 46 ]. Additional questions assessed (1) the desire to collaborate to start or improve a CV program and (2) the desire to participate in future focus groups related to barriers and facilitators of vaccine programs.…”

“…Facilitators and barriers were assessed via the question: "Which of the following do you perceive to be [facilitators/barriers] of COVID-19 vaccination to children in your ED?" using a 5-point Likert scale and a list of potential facilitators and barriers, which were selected based on the prior literature as well as a priori by the investigators and their prior research in this area [26,35,39,46]. Additional questions assessed (1) the desire to collaborate to start or improve a CV program and (2) the desire to participate in future focus groups related to barriers and facilitators of vaccine programs.…”

“…EDs are also common sites of care for patients without a medical home and without insurance, as well as those with complex medical needs who may be at increased risk of COVID-19 illness [ 36 , 37 , 38 ]. The ED also serves as a convenient site for vaccination, overcoming commonly cited barriers such as access to transportation, difficulty making an appointment, and insurance problems [ 39 , 40 ]. A recent study of 22 pediatric EDs demonstrated that Black (40%) and Hispanic (17%) children, and those with public health insurance (51%), are the primary utilizers of pediatric EDs and are more likely to have recurrent ED visits [ 41 ]; therefore, ED-based COVID-19 vaccine (CV) programs may be important strategies to increase vaccination rates among these children.…”

Should COVID-19 vaccines be mandated in schools? - an international caregiver perspective

“…ED caregivers were chosen because prior work by this study team as well as others demonstrated that children without a medical home and those from vulnerable groups (especially children age 0-5yr and those from low-income households) tend to have disproportionately high rates of ED use, thus both the Centers for Disease Control and Prevention (CDC) as well as the World Health Organization recognize the ED as an important site for engagement in vaccination efforts. [23] , [24] , [25] , [26] , [27]…”

Implementation of a COVID-19 Vaccination Program in the Emergency Department

“…As such, EDs are recognized as key targets to increase COVID-19 vaccination rates. [1][2][3] Despite an abundance of COVID-19 vaccination clinics, barriers such as vaccine hesitancy, lack of transportation, transient housing, mental health disorders, and difficulty in making an appointment have impacted vaccination rates in underserved populations. The American College of Emergency Physicians (ACEP) postulated that "rising ED volumes continue to include a disproportionately increasing underserved, uninsured and minority population [who are] less likely to have had adequate preventive and primary care access and are more likely to be under-immunized."…”