O0115 Oct.3: 4:05pm - Optimizing an Influenza Vaccination Initiative in the Pediatric Emergency Department, a Model to Overcome Vaccine Hesitancy

Background: Universal pediatric influenza vaccination is the best strategy to prevent influenza-related morbidity and mortality; however, only 50% of US children are vaccinated annually. The pediatric ED provides a unique opportunity to vaccinate children who may not otherwise receive a vaccine, but the success of prior ED vaccination efforts has been limited due to vaccine hesitancy and delays in vaccine administration. During the 2018-19 influenza season, this ED implemented mandatory screening for influenza vaccine status. Despite offering the vaccine to all eligible patients (n=13,656), only 13% (n=1,743) accepted the vaccine and 30% (n=511) of those patients left prior to vaccination. Therefore, only 9% of the eligible population (1,232 patients) received the vaccine. The team sought to optimize the vaccination process by increasing vaccine acceptance rates and ensuring every patient requesting the vaccine received it.

Objective: Improve influenza vaccination rates from 9% to 15% and administer 2,000 vaccines in eligible unvaccinated ED patients for the 2019-20 influenza season.
Methodology: A multidisciplinary team interviewed stakeholders, mapped the process, and developed four key drivers: identifying families with vaccine hesitancy, involving providers in counseling, reducing delays in administration, and developing electronic reminders to administer the vaccine. Interventions were tested using plan-do-study-act cycles. We included discharged ED patients age 6mo-18yo with an emergency severity index score 2-5 and excluded patients with a prior vaccine this season. The process measures were percent of patients screened for vaccine status, percent of eligible patients accepting the vaccine, and percent of eligible patients leaving prior to vaccination. The outcome measure was the percent of eligible patients vaccinated. The balancing measure was discharge time (printing discharge papers, administering vaccine, and actual discharge).
Results/

Discussion: Screening for vaccine status was similar for the 2018-19 and 2019-20 influenza seasons, 84% (n=23,429) vs 85% (n=24,700) respectively. Approximately 60% of patients screened were eligible for vaccination each season. Comparing the 2018-19 and 2019-20 influenza seasons, vaccine acceptance rates improved from 13% to 22% (Figure 1), and the proportion of patients leaving prior to vaccination decreased from 30% (n=511) to 10% (n=309). The team surpassed their goals as vaccination rates improved significantly from 9% to 20% from the 2018-19 to 2019-20 influenza seasons (Figure 2). In addition, a total of 2,839 children were vaccinated this influenza season, 2.3x the number of children the prior season. Discharge time for vaccinated patients improved from 20min 2018-19 to 16 minutes in 2019-20.

Conclusions: This ED influenza vaccination initiative was optimized by improving vaccine acceptance rates and ensuring every patient requesting a vaccine received it. The process provides a model to overcome vaccine hesitancy and it can be adapted and replicated for any vaccine preventable illness.