Dexheimer Judith W, Jones Ian, Chen Qingxia, Talbot Thomas R, Mason Donna, Aronsky Dominik
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
Acad Emerg Med. 2006 Dec;13(12):1312-8. doi: 10.1197/j.aem.2006.07.029. Epub 2006 Nov 13.
The emergency department (ED) has been recommended as a suitable setting for offering pneumococcal vaccination; however, implementations of ED vaccination programs remain scarce.
To understand beliefs, attitudes, and behaviors of ED providers before implementing a computerized reminder system.
An anonymous, five-point Likert-scale, 46-item survey was administered to emergency physicians and nurses at an academic medical center. The survey included aspects of ordering patterns, implementation strategies, barriers, and factors considered important for an ED-based vaccination initiative as well as aspects of implementing a computerized vaccine-reminder system.
Among 160 eligible ED providers, the survey was returned by 64 of 67 physicians (96%), and all 93 nurses (100%). The vaccine was considered to be cost effective by 71% of physicians, but only 2% recommended it to their patients. Although 98% of physicians accessed the computerized problem list before examining the patient, only 28% reviewed the patient's health-maintenance section. Physicians and nurses preferred a computerized vaccination-reminder system in 93% and 82%, respectively. Physicians' preferred implementation approach included a nurse standing order, combined with physician notification; nurses, however, favored a physician order. Factors for improving vaccination rates included improved computerized documentation, whereas increasing the number of ED staff was less important. Relevant implementation barriers for physicians were not remembering to offer vaccination, time constraints, and insufficient time to counsel patients. The ED was believed to be an appropriate setting in which to offer vaccination.
Emergency department staff had favorable attitudes toward an ED-based pneumococcal vaccination program; however, considerable barriers inherent to the ED setting may challenge such a program. Applying information technology may overcome some barriers and facilitate an ED-based vaccination initiative.
急诊科已被推荐为提供肺炎球菌疫苗接种的合适场所；然而，急诊科疫苗接种计划的实施仍然很少。
了解在实施计算机提醒系统之前急诊科医护人员的信念、态度和行为。
对一家学术医疗中心的急诊医生和护士进行了一项匿名的、五点李克特量表、46项的调查。该调查包括医嘱模式、实施策略、障碍以及对基于急诊科的疫苗接种倡议重要的因素等方面，以及实施计算机化疫苗提醒系统的相关方面。
在160名符合条件的急诊科医护人员中，67名医生中有64名（96%）和所有93名护士（100%）回复了调查问卷。71%的医生认为疫苗具有成本效益，但只有2%的医生向患者推荐。虽然98%的医生在检查患者之前会查看计算机化问题清单，但只有28%的医生会查看患者的健康维护部分。医生和护士分别有93%和82%倾向于使用计算机化疫苗提醒系统。医生首选的实施方法包括护士常规医嘱并结合医生通知；然而，护士则倾向于医生医嘱。提高疫苗接种率的因素包括改进计算机化记录，而增加急诊科工作人员数量则不那么重要。医生面临的相关实施障碍包括忘记提供疫苗接种、时间限制以及没有足够时间为患者提供咨询。急诊科被认为是提供疫苗接种的合适场所。
急诊科工作人员对基于急诊科的肺炎球菌疫苗接种计划持积极态度；然而，急诊科环境中固有的相当多障碍可能会对这样一个计划构成挑战。应用信息技术可能会克服一些障碍并促进基于急诊科的疫苗接种倡议。
