Slobodkin D, Zielske P G, Kitlas J L, McDermott M F, Miller S, Rydman R
Department of Emergency Medicine, and the Division of Emergency Nursing, Cook County Hospital, School of Public Health, University of Chicago, Chicago, IL 60612, USA.
Ann Emerg Med. 1998 Nov;32(5):537-43.
To demonstrate the feasibility of systematic immunization against influenza and pneumococcus in a public emergency department.
This was a demonstration project conducted from October 21, 1996, through December 2, 1996, at Cook County Hospital, an inner-city hospital with a 1996 adult ED census of 120,449. Seventy-eight percent of patients are uninsured; 92% are people of color; 73% deny having a primary physician. Only 15% have emergency complaints. Nurses received standing orders that all nonemergency adult patients meeting Centers for Disease Control and Prevention criteria for high risk should be offered immunization against influenza and pneumococcus at triage. Cash prizes were offered to nurses appropriately immunizing the most patients. The date of immunization was entered into the computerized patient registration system, available to all providers within the county system. From November 4 through November 18, an extra nurse was assigned to triage to test for improvement in immunization rates. A time-motion study determined the time required per immunization on the basis of a convenience sample of 8 nurses drawn from all 3 shifts.
Only 3% of identified high-risk patients reported previous pneumococcal immunization. Despite extreme variation in nurse performance, 2,631 patients (24% of patients triaged) were screened, and 716 high-risk patients were identified (27% of patients screened). A total of 1234 patients were immunized against influenza, and 241 patients were appropriately immunized against pneumococcus. Sixty-one percent of high-risk patients with no contraindication to influenza immunization were immunized against influenza. Thirty-five percent of high-risk patients not previously immunized against pneumococcus were immunized against pneumococcus. Immunizations per shift per triage nurse varied from 0 to 24. Median time for all activities related to immunization was 4 minutes (range, 2 to 10 minutes). There was no increase in immunization rates with the addition of an extra nurse at triage (95% confidence interval for odds ratio, .929 to 1.153).
Systematic immunization against influenza and pneumococcus is both needed and feasible in a public ED. "Buy-in" by nurses is variable. Increased staffing alone does not improve immunization rates.
证明在公共急诊科进行流感和肺炎球菌系统免疫接种的可行性。
这是一项于1996年10月21日至1996年12月2日在库克县医院开展的示范项目，该医院位于市中心，1996年成人急诊科普查人数为120449人。78%的患者未参保；92%为有色人种；73%的患者称没有初级医生。只有15%的患者有紧急诉求。护士接到常规医嘱，即所有符合疾病控制与预防中心高危标准的非紧急成年患者在分诊时应提供流感和肺炎球菌疫苗接种。为给最多患者进行适当疫苗接种的护士提供现金奖励。疫苗接种日期录入计算机化患者登记系统，县系统内所有医护人员均可获取。从11月4日至11月18日，增派一名护士到分诊处，以测试疫苗接种率是否提高。一项时间动作研究根据从所有三个班次抽取的8名护士的便利样本确定每次疫苗接种所需时间。
只有3%已确认的高危患者报告曾接种过肺炎球菌疫苗。尽管护士的表现差异极大，但仍对2631名患者（占分诊患者的24%）进行了筛查，确认了716名高危患者（占筛查患者的27%）。共有1234名患者接种了流感疫苗，241名患者接受了适当的肺炎球菌疫苗接种。61%无流感疫苗接种禁忌的高危患者接种了流感疫苗。35%之前未接种过肺炎球菌疫苗的高危患者接种了肺炎球菌疫苗。每个分诊护士每班的疫苗接种量从0至24不等。与疫苗接种相关的所有活动的中位时间为4分钟（范围为2至10分钟）。在分诊处增派一名护士后，疫苗接种率并未提高（优势比的95%置信区间为0.929至1.153）。
在公共急诊科进行流感和肺炎球菌系统免疫接种既必要又可行。护士的“认同度”各不相同。仅增加人员配备并不能提高疫苗接种率。
