462 - Improvement of COVID-19 Vaccination Rates in Patients with High-Risk Diagnoses Discharged from the Emergency Department

Poster Number: 462
Publication Number: 462.309

Heather Conrad, Rady Children's Hospital/University of California San Diego, Solana Beach, CA, United States; Mario Bialostozky, Rady Children's Hospital San Diego/University of California, San Diego, San Diego, CA, United States; Kristin Farkas, Rady Children's Hospital San Diego, San Diego, CA, United States; Megan Medina, Rady Children's Hospital, Chula Vista, CA, United States; Jacob Parker, Rady Children's Hospital San Diego, Bella Vista, AR, United States; Amy W. Bryl, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: High-risk conditions such as obesity, diabetes mellitus, and other chronic diseases place pediatric patients at increased risk for complications associated with COVID-19 including hospitalization and death.  Pediatric vaccines for COVID-19 have been approved and have a good safety profile.  We identified a need to increase COVID-19 vaccination in patients with high-risk conditions presenting to our pediatric emergency department (PED).

Objective: Increase the percentage of high-risk patients discharged from the PED that are eligible for the COVID-19 vaccine that are referred to the vaccine clinic and educated about the vaccine from 0% to 75% by 5/31/2022.

Design/Methods: A multidisciplinary team including pediatric emergency medicine, infectious disease, infection control, and informatics stakeholders determined key drivers and identified areas of improvement and intervention (Figure 1).  A best practice alert (BPA) in the electronic medical record (EMR) notified providers that an eligible high-risk patient had not received the COVID-19 vaccine.  The BPA linked to a discharge vaccine clinic referral which, when ordered, auto-populated discharge instructions about the COVID-19 vaccine and the vaccine clinic.  Initial PDSA cycles focused on education and optimization of the new EMR workflow and later PDSA cycles targeted provider-specific feedback.  Primary measure was the percent of discharged high-risk patients referred and educated weekly. Outcome measures included appointments made at the vaccine clinic and vaccines administered within 30 days of referral.  Balancing measures were parent complaints and return visits to the PED with vaccine complications.  We used statistical process control (SPC) to examine changes in measures over time.

Results: COVID-19 vaccine referrals for high-risk patients increased from 0% to 45% over 8 months and was sustained at 40% for an additional 3 months (Figure 2).  Two appointments were made at our vaccine clinic during the study period, although 20/540 (4%) of referred patients were vaccinated within 30 days at any location.  There were no return visits for complications from the COVID-19 vaccine.  There were no parent complaints regarding referral for the COVID-19 vaccine.  19/540 (3.5%)of referred patients were subsequently found to have already been vaccinated.

Conclusion(s): We increased the percent of high-risk patients referred and educated from 0% to 45%.  While we did not reach our goal of 75%, we increased vaccination and improved education to a high-risk population.
Slide1.jpeg

Slide1.jpeg