Improving Influenza Vaccination in the Pediatric Emergency Department.

Introduction: The American Academy of Pediatrics recommends annual influenza vaccination for patients aged 6 months or older. In 2019, our local pediatric emergency department (ED) vaccination rate was below the national average. We aimed to increase influenza vaccination screening from 53% to 95% and vaccine administration from 48% to 58% by March 2023. Methods: We included patients older than 6 months of age who were discharged from the ED, excluding those resuscitated or transferred from outside hospitals. Interventions included triage screening questions and electronic health record alerts to prompt vaccination. The baseline period was February-April 2020, with interventions during the next 3 influenza seasons, and a poststudy period from September 2023 to March 2024. Measures included vaccine administration (outcome), screening rate (process), provider discontinuation, family refusal, and discharge time (balancing). Data were analyzed using Shewhart charts (P and P'). Results: We achieved nearly universal screening for vaccine eligibility (98%) and administered the vaccine to 70% of eligible patients during season 1 of implementation. Thereafter, the influenza screening rate dropped to 85% and 86% (seasons 2 and 3, respectively) and 79% (poststudy). Likewise, influenza immunization rates decreased below baseline in season 2 (37%) and remained low at 40% (season 3) and 50% (poststudy). There was no difference in parental refusal of the vaccine at the time of discharge; however, there was an increase in provider discontinuation from 1 consecutive season to the next. Conclusions: An ED-based influenza vaccine delivery model can be successful when the triage process includes screening, a consistent group of ED-based staff orders the vaccine, and there is effective use of the electronic health record.