Work

Impact of a Quality Improvement Initiative to Increase Vaccination of Patients at High Risk of Influenza Complications at a Pediatric Hospital

Year: 2016

Type: article

Abstract: Background. An enterprise-wide comprehensive quality improvement (QI) initiative was undertaken at Lurie Children's (LC) to improve influenza vaccination coverage during the 2015–16 season. Methods. The QI initiative included: leveraging the electronic medical record (EMR) to proactively identify children as being at high risk per CDC criteria; using EMR best practice advisories to consistently remind providers to vaccinate, staging the reminders to focus on high-risk children early in the season when vaccine inventory is limited, and capturing reasons for non-vaccination; and engaging pediatric subspecialties in the vaccination program to capture high-risk children. The impact was evaluated in terms of the frequency and timing of vaccination, the subspecialty clinic associated with the doses administered, coverage of high-risk patients, and characteristics of influenza-associated pediatric intensive care unit (PICU) admissions. Results. Influenza vaccine dose administrations associated with LC encounters increased 35%, from 5979 in 2014–15 to 8059 in 2015–16 (Figure 1). Among patients flagged as high risk who were age-eligible in both seasons, the increase was 83% (from 1451 to 2650). In 2015–16, doses were administered to high-risk patients with higher frequency and earlier in the season (Figure 2). A greater number of doses were administered in 2015–16 in the subspecialties where the intervention was in place throughout the season (Figure 3). Among high-risk patients with at least one visit to these subspecialties or LC primary care during the season, 64% had vaccination documented in the EMR (including through patient report) in 2015–16, compared to 51% in 2014–15. In 2014–15 there were 30 PICU admissions associated with laboratory-confirmed influenza infection, and 12 (40%) of these had an LC encounter earlier in the season that represented a missed opportunity for vaccination. In 2015–16, 3 of the 18 (17%) influenza-related PICU admissions represented a missed opportunity. Conclusion. Compared to the previous season, implementation of the QI initiative was associated with higher numbers of vaccinations and coverage rates, and a lower rate of missed opportunities among patients admitted to the PICU. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.592