Clinical Decision Support in the Electronic Medical Record to Increase Rates of Influenza Vaccination in a Pediatric Emergency Department

Abstract

Objectives Vaccination against influenza has been shown to decrease the morbidity and mortality from the virus; however, rates remain below the Healthy People 2020 target of 70%. The emergency department (ED) provides a unique opportunity to administer influenza vaccines; however, interventions must be efficient to be successful. During the 2014 to 2015 season, an electronic medical record (EMR) intervention was implemented in an effort to increase influenza vaccination rates. Methods Using Lean methodology, a multidisciplinary team designed a series of triggers, alerts, and orders in the EMR to address the barriers to adoption and their root causes. The EMR functionality was implemented for the 2014 to 2015 influenza season. Reports on compliance with each EMR step were completed for the 2014 to 2015 and 2015 to 2016 influenza seasons. Results In the 2013 to 2014 influenza season, the ED administered 42 doses of the vaccine, representing 0.3% of eligible visits. After implementation of the EMR tool, the ED administered 1320 doses of influenza vaccine. This represents approximately 8.8% of qualified patients based on age group and eventual discharge from the ED. The results were sustained during the 2015 to 2016 influenza season with 1031 doses administered, representing 6% of eligible visits. Conclusions The ED influenza vaccination program vaccinated approximately 20 times the number of eligible patients after automated EMR screening and ordering. Using knowledge of a multidisciplinary team, integration into the existing workflow, and visual cues in the EMR, we were able to increase the number of influenza vaccines administered substantially.

A rapid global review of strategies to improve influenza vaccination uptake in Australia

“… 19 Similarly, an observational study evaluated clinical decision support in the EHR and found it to improve influenza vaccination rate by 20 times higher a year after the program’s implementation. 20 One pre-post study assessed the effectiveness of a multifaceted intervention to improve influenza vaccination rates among children in a large pediatric hospital in the USA. 21 The interventions targeted medical and nursing providers and included web-based education modules, reminders in EHR and financial incentives (an end-of-year financial bonus) for resident doctors.…”

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

“…Although interviews of ED parents suggest that 85% would be willing to receive the vaccine in the ED, 2 prior studies have incorporated screening and offering the vaccine to all eligible ED children, and only 9% of the eligible populations received vaccines. 5,8,10 Vaccination success was also reported to be limited in 14%-32% by patients leaving before vaccination each year. 8,10 Our study is novel as targeted interventions to overcome vaccine hesitancy and delays in vaccine administration significantly improved pediatric ED vaccination rates from 9% to 20% and reduced the number of children leaving before vaccination from 32% to 17%.…”

“…1 Vaccine hesitancy is defined as Despite the obvious benefits and parental support, past influenza vaccination efforts have demonstrated only modest success in the pediatric ED. 8,10 During the prior season, this ED implemented mandatory influenza vaccine screening and found 58% of children were eligible for vaccination. However, influenza vaccine acceptance rates were only 13%, and many patients left before vaccination.…”

“…5,9 Finally, prior studies have demonstrated how the electronic health record (EHR) can support ED healthcare workers to promote vaccination. 8,10…”

Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence

“…After these steps, prior ED-based preventative care interventions have demonstrated success. For example, a multidisciplinary team designed a series of triggers, alerts, and orders in the electronic medical record to establish an ED influenza vaccination program designed to identify patients not up to date with vaccinations during ED visits [26]. By utilizing these methods, the program led to an increase in vaccination rates by approximately 20% for eligible visits.…”