Emergency Medicine: Quality Improvement
Emergency Medicine 10
Bonnie L. Mathews, MD (she/her/hers)
Associate Professor of Pediatrics
UMass Memorial Children's Medical Center
Worcester, Massachusetts, United States
Influenza and Covid-19 continue to be significant causes of illness among children. Vaccinations are key tools in preventing morbidity and mortality from both Influenza and Covid. Pediatric emergency departments (PEDs) do not routinely offer vaccinations, but serve as important safety nets for patients presenting to the
The aim of this project was to implement an Influenza and Covid vaccination program in our PED, determine the impact of the program on length of stay (LOS), and improve the overall vaccination rate among pediatric patients.
Using LEAN methodology and multiple plan-do-study-act (PDSA) cycles corresponding with influenza season (September through March) from 2019-2022, a multidisciplinary team comprised of physicians, nurses, and pharmacists identified an opportunity to first offer the Influenza vaccine to eligible PED patients. In 2022, Covid vaccination was added to the project. Each PDSA cycle implemented additional measures to help increase awareness of vaccine availability and streamline the screening process and ordering of vaccinations. The final PDSA cycle integrated the vaccine screening process as part of PED triage using the hospital electronic medical record (EMR) (Figure 1). The outcome measures were the total number of pediatric patients immunized each season and the LOS for eligible patients who received vaccination compared to those who did not.
Over time, vaccination in the PED increased because of this quality improvement project, especially for Influenza (Figure 1). Figure 2 shows the number of vaccines administered in each PDSA cycle. Vaccination did not significantly impact LOS for PED patients (Figure 3).
Vaccination against infectious disease in the PED is a valuable resource to patients who otherwise have difficulty accessing care, and this project demonstrated that it is possible to vaccinate against Influenza and Covid-19 in the PED without a significant increase in LOS. With implementation of screening in the EMR, the number of patients successfully vaccinated increased substantially. While Influenza vaccine remains popular among PED patients, requests for Covid vaccination remain low.