P0137 - Influenza Vaccination in the Emergency Department-Meeting patients where they are

Influenza is a major cause of morbidity and mortality in the pediatric population. The influenza vaccine is recommended by the Center for Disease Control (CDC) and the American Academy of Pediatrics (AAP) for all children 6 months of age or older. Despite this, vaccination coverage was 62.6% among children 6 months through 17 years during the 2018–19 flu season. The CDC encourages healthcare providers to offer influenza vaccination during routine health care visits and hospitalizations.

Our hospital is a tertiary care children’s hospital in North Philadelphia and we see approximately 70,000 patients each year in the Emergency Department. Some of our patients are uninsured and some have inconsistent access to primary care, seeking urgent care in our emergency department rather than in an out-patient office. We began a quality improvement (QI) initiative to offer the vaccine to our emergency department patients and their siblings, when not contraindicated, in order to improve influenza vaccination rates in our community. Our QI project addressed health disparities by lowering barriers for recommended vaccination for poor children with inconsistent access to primary care. We worked as a multi-disciplinary team of physicians, trainees, nurses and pharmacists as well as public health officials to improve vaccination rates.

We partnered with the Philadelphia Department of Public Health Vaccines for Children program to ensure that all children under 19 would be eligible to receive vaccines, regardless of insurance status.

The initiative started in the 2018-2019 flu season, and we administered 77 flu vaccines (from January, 2019-April 2019). In the 2019-2020 flu season we increased the number to 290 (an increase of 276%).

In the 2019-2020 flu season, we started the initiative in October 2019. We notified all physicians who work in the ED about this initiative during our monthly departmental meetings. We also went to the nursing staff meetings so that the nurses were aware of the QI project and would understand why a preventative medical service was being done in the ED. In order for this project to succeed we needed sustained engagement of nursing, physicians and our registration staff. We had to overcome notions that the ED is not the appropriate place for preventive services.



Our first intervention, started November 16, was to place reminder stickers on every computer used by residents and attendings in the ED reminding them to offer the vaccine. This resulted in an increase in the number of vaccines given, this increase was sustained until November. In mid-February, we initiated our second intervention which was placing a standing order for the nurses to enable them to administer the vaccine without a doctor's order.This intervention resulted in an increase in the number of vaccines given.