331 Evaluation of Triage Screening for Influenza Vaccination Status in the Emergency Department

Abstract

Seasonal influenza places significant burden on emergency medical care and is estimated to result in 3.9 million annual emergency department (ED) encounters. Lack of access to primary medical care is associated with greater utilization of ED services. Increasingly, the ED is providing preventive care to patients, such as influenza vaccines. The objective of this study was to evaluate vaccination screening at triage to determine the potential impact of an ED-based influenza vaccine program on unvaccinated patients. This was a retrospective study of ED encounters within a single health system between October 1, 2018 and April 30, 2019. All 19 EDs, 6 freestanding EDs and 13 hospital-based EDs, were included. Data was obtained from the electronic medical record (EPIC). Encounters were reviewed to determine if influenza vaccination status was assessed at ED triage. Assessment of vaccination status by registered nurses is encouraged but not mandatory during ED triage. Influenza vaccination is not routinely offered. Encounters in which triage screening was completed had responses categorized as vaccinated, unvaccinated, or vaccination status unknown. During the study period, 359, 310 encounters occurred across 19 EDs. Screening for vaccination status was completed for 204, 173 encounters, representing 56.8% of all encounters (95% CI 0.567 to 0.57). Screening was more frequent at freestanding EDs [60%, (95% CI 0.596 to 0.604)] compared to hospital based EDs [56.2%, (95% CI 0.56 to 0.563, p < 0.001)]. Of the encounters that were screened, 73, 311 patients reported being vaccinated against influenza [35.9%, (95% CI 0.357 to 0.361)] and 103, 276 patients reported being unvaccinated [50.6%, (95% CI 0.504 to 0.508)]. Patients 0-17 years [55.5%, (95% CI 0.55 to 0.561)] or 18-64 years [57.9%, (95% CI 0.577 to 0.582)] were more likely to report being unvaccinated against influenza compared to those 65 years or older [25.7%, (95% CI 0.253 to 0.261, p < .001)]. In total, 56.8% of patients were screened for vaccination status. Patient’s report being unvaccinated against influenza in more than half of all ED encounters. Pediatric patients and adults < 65 years of age are more likely to be unvaccinated against influenza and represent a target population for ED vaccination. Increased vaccination screening is needed to accurately assess opportunities for ED-based vaccination efforts.