Use of Peer Comparison, Provider Education, and Electronic Medical Record Triggers to Increase Influenza Vaccination Rates in Hospitalized Children

Abstract

BACKGROUND: The American Academy of Pediatrics recommends annual influenza vaccination for all children 6 months and older, yet only 59% of children nationally received the vaccine during the 2014–2016 influenza seasons. Of these, only 4% received the vaccine in a hospital setting. The goal of this quality improvement (QI) initiative was to increase influenza vaccination status at discharge at least twofold in children admitted to our hospital during the 2017–2018 influenza season compared with the 2016–2017 season. METHODS: The QI initiative was conducted in the inpatient units at a tertiary care children’s hospital. Interventions included electronic medical record triggers, provider education, and peer comparison. The primary outcome measure was the percentage of children discharged from the hospital with at least 1 dose of the influenza vaccine received either at the hospital or before admission. Queries about the influenza vaccination status of children were used as a process measure. Length of stay was used as a balancing measure. RESULTS: The percentage of hospitalized children discharged with at least 1 dose of the vaccine increased 4.7-fold during the QI initiative (46%) compared with baseline (10%). There was a fourfold increase in parental query about the influenza vaccination status of their children (68%) during the QI initiative compared with the baseline period (16%). No significant difference occurred in the median length of stay among patients admitted during the QI initiative versus the baseline period. CONCLUSIONS: We increased influenza vaccination status among children admitted to our hospital using electronic medical record triggers, provider education, and peer comparison.

Knowledge Base and Perceptions of Inpatient Providers and Parents About Influenza Vaccination in Hospitalized Children

“…The strength of this study is that it provided us with specific gaps in the knowledge base and attitudes/perceptions of providers that were addressed by our educational interventions. 5 Provider education as well as other efforts during our quality improvement initiative to increase influenza vaccination at our hospital resulted in a 4.7fold increase (10% baseline vs 46% during QI initiative) in the percentage of hospitalized children discharged with at least one dose of the influenza vaccine. 5 We also believe that our survey can be utilized by providers at other institutions as an educational tool to assess the knowledge base of providers as well as educate them about the annual influenza vaccine recommendations.…”

“…We also incorporated trigger questions into our electronic medical record and modified the history and physical exam template to help remind providers to order the vaccine at the time of admission. 5 Survey results showed a dichotomy in provider and parental perceptions about influenza vaccination. A large proportion of providers cited parental refusal as a barrier to administering influenza vaccination in the inpatient setting.…”

“…We also incorporated trigger questions into our electronic medical record and modified the history and physical exam template to help remind providers to order the vaccine at the time of admission. 5 …”

“…Understanding these reasons helped us tailor our education sessions to address the safety of influenza vaccination during hospitalization for an acute illness. 5 The primary barriers reported by the medical providers to administering influenza vaccination were parental refusal and forgetting to order the influenza vaccine at the time of admission. We also incorporated trigger questions into our electronic medical record and modified the history and physical exam template to help remind providers to order the vaccine at the time of admission.…”

“…We implemented a quality improvement initiative to increase influenza vaccination rates in our children's hospital during the 2017-18 influenza season. 5 A critical element in increasing vaccination rates is provider knowledge about the influenza vaccine, which can greatly impact their ability to counsel and vaccinate their patients. Increased obstetrician knowledge about the influenza vaccine was associated with increased rates of vaccination in their patients.…”