Cleveland Clinic Akron General, Department of Emergency Medicine, 1 Akron General Ave., Akron, OH 44307, USA; Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA.
Northeast Ohio Medical University, 4209 SR-44, Rootstown, OH 44272, USA; Cleveland Clinic Akron General, Department of Pharmacy, 1 Akron General Ave., Akron, OH 44307, USA.
Am J Emerg Med. 2023 Jun;68:59-63. doi: 10.1016/j.ajem.2023.03.019. Epub 2023 Mar 13.
Seasonal influenza is associated with significant healthcare resource utilization. An estimated 490,000 hospitalizations and 34,000 deaths were attributed to influenza during the 2018-2019 season. Despite robust influenza vaccination programs in both the inpatient and outpatient setting, the emergency department (ED) represents a missed opportunity to vaccinate patients at high risk for influenza who do not have access to routine preventive care. Feasibility and implementation of ED-based influenza vaccination programs have been previously described but have stopped short of describing the predicted health resource impact. The goal of our study was to describe the potential impact of an influenza vaccination program in an urban adult emergency department population using historic patient data.
This was a retrospective study of all encounters within a tertiary care hospital-based ED and three freestanding EDs during influenza season (defined as October 1 - April 30) over a two-years, 2018-2020. Data was obtained from the electronic medical record (EPIC®). All ED encounters during the study period were screened for inclusion using ICD 10 codes. Patients with a confirmed positive influenza test and no documented influenza vaccine for the current season were reviewed for any ED encounter at least 14 days prior to the influenza-positive encounter and during the concurrent influenza season. These ED visits were deemed a missed opportunity to provide vaccination and potentially prevent the influenza-positive encounter. Healthcare resource utilization, including subsequent ED encounters and inpatient admissions, were evaluated for patients with a missed vaccination opportunity.
A total of 116,140 ED encounters occurred during the study and were screened for inclusion. Of these, 2115 were influenza-positive encounters, which represented 1963 unique patients. There were 418 patients (21.3%) that had a missed opportunity to be vaccinated during an ED encounter at least 14 days prior to the influenza-positive encounter. Of those with a missed vaccination opportunity, 60 patients (14.4%) had subsequent influenza-related encounters, including 69 ED visits and 7 inpatient admissions.
Patients presenting to the ED with influenza frequently had opportunities to be vaccinated during prior ED encounters. An ED-based influenza vaccination program could potentially reduce influenza-related burden on healthcare resources by preventing future influenza-related ED encounters and hospitalizations.
季节性流感与大量医疗资源的利用相关。据估计，在 2018-2019 年期间，有 49 万人因流感住院，34000 人死亡。尽管在住院和门诊环境中都有强大的流感疫苗接种计划，但急诊科（ED）仍然是一个错过为那些无法获得常规预防保健的流感高危患者接种疫苗的机会。以前已经描述了基于 ED 的流感疫苗接种计划的可行性和实施情况，但没有描述预测的卫生资源影响。我们的研究目标是使用历史患者数据描述城市成年急诊科人群中流感疫苗接种计划的潜在影响。
这是一项对 2018-2020 年两个流感季节（定义为 10 月 1 日至 4 月 30 日）期间在一家三级保健医院 ED 和三家独立 ED 的所有就诊进行的回顾性研究。数据来自电子病历（EPIC®）。在研究期间，所有 ED 就诊均使用 ICD 10 代码进行筛选以纳入研究。对于在当前季节没有确诊的流感阳性测试且没有记录流感疫苗的患者，在流感阳性就诊前至少 14 天且在同期流感季节内，对任何 ED 就诊进行回顾性分析。这些 ED 就诊被认为是提供疫苗接种和潜在预防流感阳性就诊的机会。对于有疫苗接种机会的患者，评估了医疗资源的利用情况，包括随后的 ED 就诊和住院。
在研究期间共发生了 116140 次 ED 就诊，并进行了筛选以纳入研究。其中，2115 次就诊为流感阳性，代表了 1963 位独特的患者。有 418 位患者（21.3%）在流感阳性就诊前至少 14 天的 ED 就诊中有机会接种疫苗。在有疫苗接种机会的患者中，有 60 位患者（14.4%）有后续的流感相关就诊，包括 69 次 ED 就诊和 7 次住院。
因流感就诊于 ED 的患者经常有机会在之前的 ED 就诊中接种疫苗。基于 ED 的流感疫苗接种计划可以通过预防未来的流感相关 ED 就诊和住院，从而潜在地减轻流感对医疗资源的负担。
