A computerized pneumococcal vaccination reminder system in the adult emergency department.
نویسندگان
چکیده
BACKGROUND Pneumococcal vaccination is an effective strategy to prevent invasive pneumococcal disease in the elderly. Emergency department (ED) visits present an underutilized opportunity to increase vaccination rates; however, designing a sustainable vaccination program in an ED is challenging. We examined whether an information technology supported approach would provide a feasible and sustainable method to increase vaccination rates in an adult ED. METHODS During a 1-year period we prospectively evaluated a team-oriented, workflow-embedded reminder system that integrated four different information systems. The computerized triage application screened all patients 65 years and older for pneumococcal vaccine eligibility with information from the electronic patient record. For eligible patients the computerized provider order entry system reminded clinicians to place a vaccination order, which was passed to the order tracking application. Documentation of vaccine administration was then added to the longitudinal electronic patient record. The primary outcome was the vaccine administration rate in the ED. Multivariate logistic regression analysis was used to estimate the odds ratios and their 95% confidence intervals, representing the overall relative risks of ED workload related variables associated with vaccination rate. RESULTS Among 3371 patients 65 years old and older screened at triage 1309 (38.8%) were up-to-date with pneumococcal vaccination and 2062 (61.2%) were eligible for vaccination. Of the eligible patients, 621 (30.1%) consented to receive the vaccination during their ED visit. Physicians received prompts for 428 (68.9%) patients. When prompted, physicians declined to order the vaccine in 192 (30.9%) patients, while 222 (10.8%) of eligible patients actually received the vaccine. The computerized reminder system increased vaccination rate from a baseline of 38.8% to 45.4%. Vaccination during the ED visit was associated younger age (OR: 0.972, CI: 0.953-0.991), Caucasian race (OR: 0.329, CI: 0.241-0.448), and longer ED boarding times (OR: 1.039, CI: 1.013-1.065). CONCLUSION The integrated informatics solution seems to be a feasible and sustainable model to increase vaccination rates in a challenging ED environment.
منابع مشابه
Prospective Evaluation of a Closed-Loop, Computerized Reminder System for Pneumococcal Vaccination in the Emergency Department
The Emergency Department is a suitable but challenging environment to implement a sustainable pneumococcal vaccination program. To increase vaccination rates for patients > or equal to 65 years old, we prospectively evaluated a closed-loop informatics approach over a 6-week study period. Among the 572 candidate patients, 284 were up-to-date with vaccination, 187 patients refused vaccination, 65...
متن کاملInpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial.
CONTEXT Computerized reminder systems increase influenza and pneumococcal vaccination rates, but computerized standing order systems have not been previously described or evaluated. OBJECTIVE To determine the effects of computerized physician standing orders compared with physician reminders on inpatient vaccination rates. DESIGN, SETTING, AND PATIENTS Randomized trial of 3777 general medic...
متن کاملInfluenza and pneumococcal vaccinations in dialysis patients in a London district general hospital
BACKGROUND Patients on dialysis mount reduced immune responses compared with the general population. The Department of Health advises that these patients receive influenza and pneumococcal vaccinations at regular intervals-once yearly and every five years, respectively. This article investigates the uptake of these vaccinations in this patient population and seeks to examine factors that may in...
متن کاملImmunogenicity of 23-Valent Pneumococcal Vaccine in Children with Systemic Lupus Erythematosus
Background: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease which is characterized by B-cell abnormality and auto-antibody generation. Since bacterial infections are the most important causes of mortality in these patients, pneumococcal vaccination is recommended for children with SLE. Objective: To investigate humoral immunity and specific-antibody formation in response to a...
متن کاملGlobal Coverage of Pneumococcal Conjugate Vaccine (PCV) and Serotype Distribution after Receiving Vaccine among Targeted PCV Vaccine Countries: A Systematic Review
Background and Objectives: After the introduction of the pneumococcal vaccine, an increase has been observed in the disease due to nonspecific stereotypes of the vaccine. This study was conducted to determine the spatial distribution of pneumococcal vaccine coverage and common stereotypes of streptococcus pneumonia after vaccine introduction in the vaccine recipient countries. Methods: The ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Vaccine
دوره 29 40 شماره
صفحات -
تاریخ انتشار 2011