Evaluation of an influenza vaccine administration program in the emergency department

Background

The Emergency Department (ED) offers the opportunity to expand vaccine prevention interventions. However, the processes, outcomes, and sustainability of ED influenza vaccination remain largely uncharacterized. We report the outcomes of a low-intensity, electronic health record (EHR) facilitated, ED influenza vaccination initiative.

Methods

This retrospective evaluation of an ED influenza vaccination program used existing EHR records of ED encounters from 2019 to 2023 at two affiliated urban EDs. The ED influenza vaccination program launched September 2020 and continued during annual influenza seasons. Nurses assessed eligibility and administered vaccine by protocol based on passive electronic health record best practice advisories (BPAs). Implementation efforts were limited to BPA programming with email and staff meeting announcements. Descriptive statistics were used to compute the primary outcome of the number of ED influenza vaccine administrations by year.

Results

After vaccinating 18 individuals in the year prior to launch, the program vaccinated 271 individuals (225 year 1; 41 year 2; 5 year 3). In the 3-year evaluation period, nurses acknowledged 10,558 (8.9 %) BPAs, of which 116 (1.1 %) were excluded due to contraindications, 10,000 (94.7 %) were documented as “vaccine offer declined”, and 442 (4.2 %) agreed to vaccination.

Conclusion

A nursing driven ED influenza vaccination protocol may enable vaccination, but successful ED influenza vaccination was minimal in this experience featuring limited implementation procedures. The passive BPA was most often not acknowledged and when acknowledged resulted in a high refusal rate possibly due to erroneous documentation. A program of research in ED care processes, staff motivation, and health policy is required to leverage EDs as vaccination sites.