Castillo Edward M, Chan Theodore C, Tolia Vaishal M, Trumm Nicholas A, Powell Robert A, Brennan Jesse J, Kreshak Allyson A
Department of Emergency Medicine, University of California San Diego, San Diego, California.
Department of Pharmacy, University of California San Diego, San Diego, California.
J Emerg Med. 2018 Dec;55(6):764-768. doi: 10.1016/j.jemermed.2018.09.004. Epub 2018 Oct 10.
While the overall incidence of hepatitis A has declined markedly since the introduction of a vaccine, sporadic cases and outbreaks of the disease continue to occur.
Our aim was to evaluate the effectiveness of an electronic health record (EHR) provider alert as part of an outbreak-control vaccination program implemented in the emergency department (ED).
We conducted a retrospective study assessing the impact of a Best Practice Alert (BPA) built into an EHR to prompt providers when a patient was homeless to consider hepatitis A vaccination in the ED. Data were collected over three 6-month time periods: a historical control period, a pre-intervention period, and an intervention period.
There were no vaccinations given in the ED in the historical period, which increased to 465 after the implementation of the BPA. During the implementation period, there were 1,482 visits identified among 1,131 patients that met the inclusion criteria. Of these, there were 1,147 (77.5%) visits where the patient either received the vaccine in the ED, had already received the vaccine, or it was not indicated due to the current medical issue. There were also 333 (22.5%) visits where the BPA was active for potential vaccination eligibility, but did not receive it in the ED.
We leveraged an informatics tool developed within our EHR to identify high-risk patients and remind providers of the availability of vaccination in the ED. Using these tools enabled providers to increase vaccination efforts within our ED to help control the community-wide outbreak.
自疫苗引入以来，甲型肝炎的总体发病率显著下降，但该疾病的散发病例和疫情仍不断出现。
我们的目的是评估电子健康记录（EHR）提供者警报作为急诊科（ED）实施的疫情控制疫苗接种计划一部分的有效性。
我们进行了一项回顾性研究，评估EHR中内置的最佳实践警报（BPA）在患者无家可归时提示提供者在ED中考虑接种甲型肝炎疫苗的影响。数据在三个6个月时间段内收集：一个历史对照期、一个干预前期和一个干预期。
历史时期ED中未进行疫苗接种，BPA实施后增加到465例。在实施期间，在符合纳入标准的1131名患者中确定了1482次就诊。其中，有1147次（77.5%）就诊患者在ED中接种了疫苗、已经接种了疫苗或因当前医疗问题无需接种。还有333次（22.5%）就诊时BPA提示可能符合疫苗接种条件，但患者在ED中未接种。
我们利用EHR中开发的信息学工具识别高危患者，并提醒提供者ED中有疫苗可供接种。使用这些工具使提供者能够加强我们ED内的疫苗接种工作，以帮助控制社区范围的疫情。
