PC3047: Perceived Barriers to COVID-19 Vaccine Administration in Emergency Department

Background: COVID-19 vaccination rates in the approved pediatric population remain lower than in older cohorts. Barriers to vaccination include parental concerns about vaccine safety and efficacy and access to vaccination. Leveraging the Emergency Department (ED) as a vaccination site could decrease barriers to vaccination for those patients already in the ED for care.
To increase access and promote COVID-19 vaccination our urban pediatric ED began offering COVID-19 vaccines to patients in September 2021. However, vaccinations provided in our ED remain low, with fewer than 50 delivered in 6 months. This study aims to characterize perceived barriers to COVID-19 vaccinations and suggestions for improvement from ED staff members.

Methods: Investigators sent electronic surveys to all ED physicians, nurses, and pharmacists. The anonymous and voluntary survey was emailed to all staff members over a 1-month period from 1/10/2022 to 2/10/2022. The survey began with 12 closed-ended questions developed by the investigators based on observation and prior experience with COVID-19 vaccination process in the ED. These questions focused on individual experience and comfort with COVID-19 vaccination and on staff work burden. Two open-ended questions on barriers to vaccination and recommendations for improvement were also included. Binary and categorical variables were compared using the χ2 test of homogeneity or the Fisher exact test to assess differences between responses from providers and nurses. P values <.05 were considered significant. The open-ended qualitative responses were blindly reviewed for themes by each investigator and serially compared until thematic list was exhaustive of each response.

Results: The survey was completed by 72 individuals: 47 providers (MD, PA, NP), 20 nurses, 4 pharmacists, and one person in an unidentified role, representing 48% of providers, 25% of nurses, and 57% of pharmacists. All participants were vaccinated against COVID-19. The vast majority agree that COVID-19 vaccination for all staff and children are important. Additionally, the majority of staff in each role report professional burnout (Figure 1). Provider and nurse respondents statistically disagree on appropriateness of utilizing the ED for COVID-19 vaccination, how it would contribute to ending the pandemic, and its effect on professional burnout. Respondents identified staffing levels, time and patient concerns as major barriers to implementing COVID-19 vaccination in the ED (Figure 2).

Conclusion: The Pediatric ED is an available access point for vaccination and education and has the potential to reach populations with low health care access. However, professional burnout is high throughout staff in the ED and staff willingness and time to vaccinate remains a challenge. Respondents identified many valid staffing and workflow concerns as barriers to implementation. COVID-19 vaccination implementation in the Emergency Department should only be implemented if staffing and burnout is concurrently addressed.