A review of acute care interventions to improve inpatient pneumococcal vaccination

Kim, Sujin; Hughes, Christine; Sadowski, Cheryl A

doi:10.1016/j.ypmed.2014.07.015

Cited by 8 publications

(3 citation statements)

References 45 publications

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“… 23 , 24 , 25 , 26 A review of 35 studies found that the association of CDS with promoting inpatient pneumococcal vaccine in adults varied widely. 27 A qualitative study of physicians’ desired characteristics for influenza vaccine alerts noted that CDS needed to show up early during a patient visit, automatically identify patients eligible for the influenza vaccine, facilitate vaccine ordering, and generate appropriate documentation. 28 We hypothesize that a CDS system incorporating these characteristics and iteratively designed through formative usability testing with frontline clinicians would improve influenza vaccination rates among eligible hospitalized children.…”

Section: Introductionmentioning

confidence: 99%

“…However, the association of CDS with process measures and patient outcomes has been inconsistent, particularly in promoting health maintenance interventions in acute care settings . A review of 35 studies found that the association of CDS with promoting inpatient pneumococcal vaccine in adults varied widely . A qualitative study of physicians’ desired characteristics for influenza vaccine alerts noted that CDS needed to show up early during a patient visit, automatically identify patients eligible for the influenza vaccine, facilitate vaccine ordering, and generate appropriate documentation .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge

et al. 2021

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IMPORTANCE Hospitalized children are at increased risk of influenza-related complications, yet influenza vaccine coverage remains low among this group. Evidence-based strategies about vaccination of vulnerable children during all health care visits are especially important during the COVID-19 pandemic. OBJECTIVE To design and evaluate a clinical decision support (CDS) strategy to increase the proportion of eligible hospitalized children who receive a seasonal influenza vaccine prior to inpatient discharge. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted among children eligible for the seasonal influenza vaccine who were hospitalized in a tertiary pediatric health system providing care to more than half a million patients annually in 3 hospitals. The study used a sequential crossover design from control to intervention and compared hospitalizations in the intervention group (2019-2020 season with the use of an intervention order set) with concurrent controls (2019-2020 season without use of an intervention order set) and historical controls (2018-2019 season with use of an order set that underwent intervention during the 2019-2020 season). INTERVENTIONS A CDS intervention was developed through a user-centered design process, including (1) placing a default influenza vaccine order into admission order sets for eligible patients, (2) a script to offer the vaccine using a presumptive strategy, and (3) just-in-time education for clinicians addressing vaccine eligibility in the influenza order group with links to further reference material. The intervention was rolled out in a stepwise fashion during the 2019-2020 influenza season. MAIN OUTCOMES AND MEASURES Proportion of eligible hospitalizations in which 1 or more influenza vaccines were administered prior to discharge. RESULTS Among 17 740 hospitalizations (9295 boys [52%]), the mean (SD) age was 8.0 (6.0) years, and the patients were predominantly Black (n = 8943 [50%]) or White (n = 7559 [43%]) and mostly had public insurance (n = 11 274 [64%]). There were 10 997 hospitalizations eligible for the influenza vaccine in the 2019-2020 season. Of these, 5449 (50%) were in the intervention group, and 5548 (50%) were concurrent controls. There were 6743 eligible hospitalizations in 2018-2019 that served as historical controls. Vaccine administration rates were 31% (n = 1676) in the intervention group, 19% (n = 1051) in concurrent controls, and 14% (n = 912) in historical controls (P < .001). In adjusted analyses, the odds of receiving the influenza vaccine were 3.25 (95% CI, 2.94-3.59) times higher in the intervention group and 1.28 (95% CI, 1.15-1.42) times higher in concurrent controls than in historical controls. (continued) Key Points Question Is a clinical decision support (CDS) strategy associated with improved influenza vaccination rates before discharge among eligible hospitalized children? Findings In this quality improvement study, the combinination of a defaultchecked influenza vaccine order in admission order sets for eligible p...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge

et al. 2021

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“…8 As a comparison, influenza and pneumococcal vaccination rates in the inpatient setting have been shown to be as high as 67.0% on average. 9,10 Additionally, inpatient vaccinations represent a unique opportunity to provide needed health services to underserved patient populations with resource restrictions. [11][12][13][14] One solution to increase vaccination rates is to utilize clinical decision support systems (CDSSs), which use pertinent patient information to guide and improve health-related decision-making.…”

Section: Background and Significancementioning

confidence: 99%

An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies

Black,

Snyder,

Zhou

et al. 2024

Appl Clin Inform

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Background: Despite mortality benefits, only 19.9% of US adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. Objective: Evaluate if an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. Methods: This was a quasi-experimental pre-post interventional design study at an academic and community hospital in the western United States between 1/1/2021 and 10/31/2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation. Results: Vaccine ordering rates increased from 4.0% to 13.0% at the academic hospital (OR 4.01, 95% CI 3.39 to 4.74, p < 0.001) and from 7.4% to 11.6% at the community hospital (OR 1.62, 95% CI 1.23 to 2.13, p < 0.001) after alert implementation. Administration increased post-alert from 3.6% to 12.7% at the academic hospital (OR 3.21, 95% CI 2.70 to 3.82, p < 0.001), but was unchanged at the community hospital, 6.7% to 6.7% (OR 0.99, 95% CI 0.73 to 1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital. Conclusion: Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides rationale for subsequent qualitative workflow analysis with alert implementation.

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Clinical Prevention

Zoorob¹,

Grubb²,

Levine³

2020

Family Medicine

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A review of acute care interventions to improve inpatient pneumococcal vaccination

Cited by 8 publications

References 45 publications

Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge

Evaluation of a Clinical Decision Support Strategy to Increase Seasonal Influenza Vaccination Among Hospitalized Children Before Inpatient Discharge

An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies

Clinical Prevention

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