ABSTRACT
Study Objectives: Apart from tetanus and rabies vaccines, emergency departments have been minimally involved in vaccination efforts. As the country and the world continues to fight the COVID19 pandemic, determining new methods to deliver vaccines to people are now more important than ever. Moreover, finding ways to reach populations that are less likely to receive vaccines is equally as important. The objective of this study was to implement a screening and delivery protocol for influenza vaccine in an emergency department setting to demonstrate that emergency department vaccination protocols are viable and an effective public health tool. Methods: A screening protocol was developed based on CDC/ACIP guidelines for influenza vaccination. This screening protocol was implemented at two surban academic emergency departments starting 10/01/2020 and ending 01/31/2020. Demographic information was collected through electronic medical records for all patients who were screened. That information was utilized to analyze patients who accepted and those who refused the vaccine and those that ultimately received the vaccine while in the department. Results: During the trial period, 11, 355 patients were screened out of 25, 485 total patients who utilized the participating emergency departments. Of those screened, 5, 056 (45%) stated they had not received the influenza vaccine. Amongst those 5, 056 patients eligible for the vaccine, 1, 156 (22.9%) had an order placed for vaccine and ultimately 441 (8.7%) received the vaccination. The median ED length of stay (LOS) for all patients presenting to the department was 5 hours and 4.7 hours for patients who had the flu shot ordered. After omitting excessive LOS patients - greater than 16 hours, there was no evidence that having a flu shot ordered was associated with a longer ED length of stay (p < 0.05). Amongst the participants, the patients identifying as African American or Hispanic were less likely to have already received the influenza vaccine compared to non-Hispanic white and Asian identifying patients. Patients identifying as African American were the least likely to accept vaccination. Conversely, patients identifying as Hispanic were more likely than those not identifying as Hispanic to accept vaccination. Patients identifying as Asian were the most likely to have already received the vaccine and to accept the vaccine when offered. Conclusions: This study demonstrates that influenza vaccination protocols are both feasible and effective at distributing influenza vaccine in the emergency department without significantly affecting the length of stay. The patient population utilizing the emergency department is more likely to represent medically underserved populations. Influenza vaccination in the emergency department serves as an opportunity to increase vaccination rates among patients who lack other regular access to healthcare. These results should motivate the implementation of vaccination programs in other emergency departments.
ABSTRACT
Background: Coronavirus Disease 2019 (COVID-19) has heightened the importance of emergency department (ED) providers in initiating advance care planning (ACP) conversations. Clarifying ACP helps ensure care is aligned with patients' wishes and can avoid unnecessary suffering. The objective was to determine the effect of a training for emergency providers on ACP conversations in the ED during the COVID-19 pandemic. We hypothesized that the intervention would increase the documentation of advance care planning in the emergency department. Methods: This was an observational pre-/post-interventional study at a southeastern academic emergency department. Palliative care physicians carried out a three-fold educational intervention for emergency medicine providers on April 1, 2020 including: (1) an evidence-based guide to COVID-19 risk stratification, (2) education on language to initiate ACP conversations, and (3) instructions on how to document ACP preferences in the electronic health record. A medical student was trained on manual chart review of COVID-infected patients. Data was then abstracted on patient demographics, placement of code status orders, documentation of a healthcare decision maker (HCDM), and documentation of ACP. Results: In total, 143 charts of confirmed COVID-19 patients were reviewed between March 26, 2020 and May 25, 2020. There were 28 patients in the pre-intervention period and 115 post-intervention. There was a roughly ∼25% increase in ACP-related activities among emergency providers in the post-intervention period (25.0% v 49.6% ACP activities noted in the pre-and post-intervention subjects, respectively ;p < 0.03). After adjustment for patient demographics, a non-significant trend towards increased ACP activity was observed (OR = 2.54, p = 0.08). Conclusion: We present preliminary evidence that a simple physician-facing educational intervention can improve ED-based goals of care conversation and documentation for patients infected with COVID-19.