临床决策支持可减少急诊科不必要的破伤风疫苗接种。

Clinical Decision Support Reduces Unnecessary Tetanus Vaccinations in the Emergency Department.

机构信息

Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA; Massachusetts General Brigham Digital Health, Boston, MA; Harvard Medical School, Boston, MA.

Massachusetts General Brigham Digital Health, Boston, MA.

出版信息

Ann Emerg Med. 2021 Sep;78(3):370-380. doi: 10.1016/j.annemergmed.2021.02.021. Epub 2021 May 8.

DOI:10.1016/j.annemergmed.2021.02.021

PMID:33975733

Abstract

STUDY OBJECTIVE

Tetanus is the most common vaccination given in the emergency department; yet, administrations of tetanus vaccine boosters in the ED may not comply with the US Centers for Disease Control and Prevention's recommended vaccination schedule. We implemented a clinical decision support alert in the electronic health record that warned providers when ordering a tetanus vaccine if a prior one had been given within 10 years and studied its efficacy to reduce potentially unnecessary vaccines in the ED.

METHODS

This was a retrospective, quasi-experimental, 1-group, pretest-posttest study in 3 hospital EDs in Boston, MA. We studied adult patients for whom tetanus vaccines were ordered despite a history of vaccination within the prior 10 years. We compared the number of potentially unnecessary tetanus vaccine administrations in a baseline phase (when the clinical decision support alert was not visible) versus an intervention phase.

RESULTS

Of eligible patients, 22.1% (95% confidence interval [CI] 21.8% to 22.4%) had prior tetanus vaccines within 5 years, 12.8% (95% CI 12.5% to 13.0%) within 5 to 10 years, 3.8% (95% CI 3.6% to 3.9%) more than 10 years ago, and 61.3% (95% CI 60.9% to 61.7%) had no prior tetanus vaccination documentation. Of 60,983 encounters, 337 met the inclusion criteria. A tetanus vaccination was administered in 91% (95% CI 87% to 96%) of encounters in the baseline phase, compared to 55% (95% CI 47% to 62%) during the intervention. The absolute risk reduction was 36.7% (95% CI 28.0% to 45.4%), and the number of encounters needed to alert to avoid 1 potentially unnecessary tetanus vaccine (number needed to treat) was 2.7 (95% CI 2.2% to 3.6%). For patients with tetanus vaccines within the prior 5 years, the absolute risk reduction was 47.9% (95% CI 35.5 % to 60.3%) and the number needed to treat was 2.1 (95% CI 1.7% to 2.8%).

CONCLUSION

A clinical decision support alert that warns ED clinicians that a patient may have an up-to-date tetanus vaccination status reduces potentially unnecessary vaccinations.

摘要

研究目的

破伤风是急诊科最常接种的疫苗；然而，在急诊科给予破伤风疫苗加强剂可能不符合美国疾病控制与预防中心推荐的疫苗接种时间表。我们在电子病历中实施了临床决策支持警报，如果在过去 10 年内曾接种过破伤风疫苗，则向提供者发出警告，并研究其减少急诊科潜在不必要疫苗接种的效果。

方法

这是在马萨诸塞州波士顿的 3 家医院急诊科进行的回顾性、准实验、单组、前后测试研究。我们研究了尽管在过去 10 年内有过疫苗接种史，但仍因破伤风而接受疫苗接种的成年患者。我们比较了在基线阶段（临床决策支持警报不可见时）和干预阶段中潜在不必要的破伤风疫苗接种数量。

结果

在符合条件的患者中，22.1%（95%置信区间[CI] 21.8%至 22.4%）在 5 年内有过破伤风疫苗接种，12.8%（95% CI 12.5%至 13.0%）在 5 至 10 年内，3.8%（95% CI 3.6%至 3.9%）超过 10 年前，61.3%（95% CI 60.9%至 61.7%）没有破伤风疫苗接种记录。在 60983 次就诊中，有 337 次符合纳入标准。在基线阶段，91%（95% CI 87%至 96%）的就诊中给予了破伤风疫苗接种，而在干预阶段中，55%（95% CI 47%至 62%）给予了破伤风疫苗接种。绝对风险降低了 36.7%（95% CI 28.0%至 45.4%），避免 1 次潜在不必要的破伤风疫苗接种所需的就诊次数（需要治疗的人数）为 2.7（95% CI 2.2%至 3.6%）。对于在过去 5 年内接种过破伤风疫苗的患者，绝对风险降低了 47.9%（95% CI 35.5%至 60.3%），需要治疗的人数为 2.1（95% CI 1.7%至 2.8%）。