319 - Sustaining an ED-based influenza vaccine initiative despite record volumes and nursing turnover

Successful QI programs are frequently challenged by competing clinical priorities and staffing turn over.  Prior to the 2020 COVID-19 Pandemic, our successful ED influenza vaccination program screened 80% of patients and vaccinated 15-25% of eligible patients, 1000-3000 children per season. The hospital suspended the program during 2021-22 influenza season to conserve resources due to a surge in patient volumes (1,087 vs 577 patients/week) and nursing shortages (39% of goal full time effort positions).  In 2022-23 the team was challenged with sustaining its vaccination program despite a second surge in ED volumes (1,431 patients/week), significant nursing turnover (36% new hires), and lower vaccine acceptance in the Wisconsin community (34% vs 41% overall vaccination rates in Dec 2022 vs 2020).

Objective:

Sustain vaccination rates in unvaccinated ED patients age 6mo-18yr at 25% vaccinated/eligible.

Design/Methods:

A multidisciplinary team interviewed ED stakeholders and performed failure modes and effects analysis to develop three key drivers of success: educate new staff and promote buy-in, optimize vaccine workflows to accommodate volume surge, and promote parent vaccine confidence (Figure 1). Interventions including frequent nursing/provider feedback/recognition, shared vaccination responsibility and reminders in the electronic health record, and scripted vaccine recommendations to parents were tested using plan-do-study-act cycles. We included discharged ED patients age 6mo-18yo with an emergency severity index score 2-5 and excluded patients with a prior vaccine this season. The process measures included percent of patients screened for vaccine status and percent eligible. Outcome measures included percent of eligible patients vaccinated and total number of vaccines administered. Balancing measure was ED length of stay.

Results:

We compared the 2020-21 and 2022-23 influenza seasons as no vaccines were administered during the same timeframe in the 2021-2022 season (Figure 2). ED volumes were more than 2x greater during the 2022-2023 season (7,505 vs 16,008 patients). While the percent screened decreased from 89% to 57%, the total number of patients screened improved (6,710 vs 9,081 patients). Vaccine eligibility increased during the 2022-2023 season (69% vs 77%). Percent vaccinated was relatively stable 25% vs 24%, and total number of vaccines administered improved from 1,189 to 1,673 despite starting the program 2wk later. ED length of stay increased from 145min to 179min.  

Conclusion(s):

We successfully sustained a vaccination program despite record ED volumes and significant nursing turnover.