Assessment of a COVID-19 vaccination protocol for unhoused patients in the emergency department.

BACKGROUND: We aimed to evaluate the feasibility of implementing an emergency department (ED)-based Coronavirus Disease of 2019 (COVID-19) vaccination protocol in a population of unhoused patients. METHODS: On June 10, 2021, a best practice alert (BPA) was implemented that fired when an ED provider opened the charts of unhoused patients and prompted the provider to order COVID-19 vaccination for eligible patients. We downloaded electronic medical record data of patients who received a COVID-19 vaccine in the ED between June 10, 2021 and August 26, 2021. The outcomes of interest were the number of unhoused, and the total number of patients vaccinated for COVID-19 during the study period. Data were described with simple descriptive statistics. RESULTS: There were 25,871 patient encounters in 19,992 unique patients (mean 1.3 visits/patient) in the emergency department during the study period. There were 1,474 (6% of total ED population) visits in 1,085 unique patients who were unhoused (mean 1.4 visits/patient). The BPA fired in 1,046 unhoused patient encounters (71% of PEH encounters) and was accepted in 79 (8%). Forty-three unhoused patients were vaccinated as a result of the BPA (4% of BPA fires) and 18 unhoused patients were vaccinated without BPA prompting. An additional 76 domiciled patients were vaccinated in the ED. CONCLUSIONS: Implementing an ED-based COVID-19 vaccination program is feasible, however, only a small number of patients underwent COVID-19 vaccination. Further studies are needed to explore the utility of using the ED as a setting for COVID-19 vaccination.

Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians.

INTRODUCTION: Aortic valve stenosis (AS) is present in up to 10% of individuals over age 80 years. Transcatheter aortic valve replacement (TAVR) has become the most common method to replace the aortic valve in patients with AS. TAVR-related complications may occur. OBJECTIVE: This narrative review evaluates the emergency department (ED) assessment and management of patients with TAVR complications. DISCUSSION: Post-TAVR complications can be conceptualized as occurring peri-procedurally and after the peri-procedural period. Peri-procedural complications include device landing zone rupture, coronary artery obstruction, acute myocardial infarction, cardiac tamponade, and valve embolization. Complications beyond the peri-procedural window include vascular access/bleeding, mechanical valve issues, electrical conduction complications, and end-organ damage. CONCLUSIONS: Emergency clinicians are more likely to encounter TAVR complications after the initial procedural hospitalization and must be prepared to diagnose and manage these complications.