An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak

BMJ Open Quality

article

Miriam A. Bukhsh¹  Rama Thyagarajan²  Brett Todd³  Nai-Wei Chen⁴  Lihua Qu⁵  Lakshmi Swaminathan⁶ 

[1] Department of Emergency Medicine, School of Medicine and Health Sciences , The George Washington University;Department of Internal Medicine, Dell Medical School , The University of Texas at Austin;Department of Emergency Medicine , Beaumont Hospital - Royal Oak , Royal Oak;Division of Informatics and Biostatistics , Beaumont Research Institute , Royal Oak;Outcomes Research Department , Beaumont Research Institute , Royal Oak;Hospital Medicine , St Joseph Mercy Ann Arbor Hospital

关键词: Decision support;    computerised;    Electronic Health Records;    Emergency department;    Infection control;    Vaccination;   

DOI  :  10.1136/bmjoq-2022-001876

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background In response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system.Methods All patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention.Results During the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA’s use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time.Conclusions EMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND