Wright-Patterson Medical Center, Emergency Department, Wright-Patterson AFB, OH 45433, USA.
Wright State University Boonshoft School of Medicine, MD program student, Fairborn, OH 45324, USA.
Mil Med. 2023 Aug 29;188(9-10):2844-2849. doi: 10.1093/milmed/usac225.
Influenza infection in the United States results in hundreds of thousands of hospitalizations and 12,000 to 60,000 yearly deaths. Influenza season sees a sharp increase in emergency department (ED) patients nationwide, as primary care offices become overwhelmed. Because the ED is unique in its reach of underserved communities, ED vaccination programs can help maximize the number of people protected by vaccination. Influenza vaccination is one of the only vaccines that occurs yearly; therefore, successes with ED distribution of the influenza vaccine can potentially be translated into efforts of vaccinating the U.S. population more efficiently against other viral illnesses, such COVID-19. There has also not been a previous description in the literature of a vaccination program being used in a military setting. The original purpose of this study was to measure the effect of an ED vaccination program on our vaccine penetration and ED length of stay as well as to analyze the impact of provider education on vaccine uptake on vaccine refusal.
This was an observational, quality improvement project in the Wright-Patterson Medical Center Emergency Department evaluating an influenza vaccination program set to last from October 1, 2020 to April 1, 2021. Patients were to be surveyed to assess prior vaccination status, identify those at high risk for influenza complications, and to measure the effects of point-of-care education on vaccine acceptance. Separate measurements included average ED length of stay and the study's impact on how quickly the base population could be vaccinated.
The effort was determined no longer feasible on November 20, 2020 because of the significant barriers. Although no data were gathered, we were able to glean important information that is vital in future efforts to implement ED-based vaccination programs. Reasons for program failure were multi-factorial, but were mainly attributed to rapid implementation, issues with Pyxis ordering and vaccine shipments, and vaccine storage capacity. The program also lacked a multidisciplinary implementation team of nurses and technicians, which could have better anticipated critical barriers.
Influenza has caused multiple worldwide pandemics, contributed to countless deaths, and continues to be a challenge. ED-based influenza vaccination programs have been trialed to augment the primary care system in their effort to prevent deaths from influenza. The literature has shown that these programs are cost-effective and efficacious, but significant barriers have stunted their widespread utilization. Examining the rapid implementation and failure of this program highlights the importance of implementation models, process and barrier mapping, and proper operationalization. It is also the first such program that has been trialed in a military treatment facility. In consideration of the recent pandemic, successful ED-based vaccination programs can also offer a model for additional dissemination of other vaccines, such as the COVID-19 vaccine.
在美国，流感感染导致成千上万的人住院治疗，每年有 1.2 万至 6 万人死亡。流感季节，全国范围内的急诊科（ED）患者急剧增加，因为初级保健办公室不堪重负。由于 ED 独特的服务对象是服务不足的社区，因此 ED 疫苗接种计划可以帮助最大限度地增加接种疫苗的人数。流感疫苗是唯一一种每年都需要接种的疫苗；因此，ED 分发流感疫苗的成功经验，可能会转化为更有效地为美国人口接种其他病毒性疾病疫苗（如 COVID-19 疫苗）的努力。此外，以前文献中也没有描述过在军事环境中使用疫苗接种计划。本研究的最初目的是衡量 ED 疫苗接种计划对我们的疫苗接种率和 ED 住院时间的影响，以及分析提供者教育对疫苗接种率和疫苗接种拒绝的影响。
这是在莱特-帕特森医疗中心急诊科进行的一项观察性、质量改进项目，评估了一项从 2020 年 10 月 1 日至 2021 年 4 月 1 日持续的流感疫苗接种计划。对患者进行调查，以评估其先前的疫苗接种状况，确定有流感并发症高风险的人群，并衡量即时护理教育对疫苗接受度的影响。单独的测量包括平均 ED 住院时间和该研究对基础人群接种疫苗速度的影响。
由于存在重大障碍，该计划于 2020 年 11 月 20 日被确定不再可行。尽管没有收集数据，但我们能够收集到重要信息，这些信息对于未来实施 ED 疫苗接种计划至关重要。计划失败的原因是多方面的，但主要归因于快速实施、Pyxis 订单和疫苗运输问题以及疫苗储存能力问题。该计划还缺乏护士和技术人员的多学科实施团队，这可能会更好地预测关键障碍。
流感已在全球范围内引发多次大流行，导致无数人死亡，并继续构成挑战。ED 流感疫苗接种计划已被试用，以补充初级保健系统，预防流感导致的死亡。文献表明，这些计划具有成本效益和效果，但重大障碍阻碍了它们的广泛应用。该计划的快速实施和失败凸显了实施模式、流程和障碍映射以及适当运作的重要性。这也是首个在军事医疗机构试用的此类计划。考虑到最近的大流行，成功的 ED 疫苗接种计划也可以为其他疫苗（如 COVID-19 疫苗）的进一步传播提供模式。
