Improving Influenza Vaccine Uptake in Acute Care Settings

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Successful development and implementation of clinical decision support to promote uptake of influenza vaccine in pediatric acute care increased vaccine rates among hospitalized children.

Project Details -
Completed

Influenza vaccination is critical in preventing illnesses, hospitalizations, and deaths, particularly among children. Vaccination rates in hospitalized children are lower than the national average, potentially due to staff being unaware of their patient’s immunization status. Previous efforts to improve vaccination rates have included automated screening tools, education initiatives, and reminder systems, but many of these interventions may not be effective and require ongoing maintenance. Clinical decision support (CDS) tools are an alternate option that provide clinicians with knowledge and patient-specific information at appropriate times in the healthcare workflow to inform decision making and improve quality of care.

Researchers developed and implemented three CDS interventions to improve influenza vaccine uptake in hospitalized children. The interventions included prechecked vaccine orders in admission order sets; non-interruptive vaccine status notifications; and a conditional discharge alert to nudge nurses to administer the vaccine prior to discharge. The study also assessed the tools’ reach, efficacy, adoption, implementation, and maintenance, to determine effectiveness.

The specific aims of the research were as follows:

  • Design CDS to promote influenza vaccine uptake in pediatric acute care settings with a user-centered design approach.
  • Evaluate implementation of effectiveness using the RE-AIM framework.

The study team conducted informal stakeholder interviews of ward nurses, pediatric residents, attending physicians, and pharmacists to identify barriers to vaccine administration and inform CDS development. An overview of the electronic health-record based tools was provided to nurses and residents during educational sessions prior to implementation. The primary outcome measure was the proportion of eligible hospitalizations with at least one dose of influenza vaccine administered prior to discharge. Researchers evaluated the CDS impact on vaccine administration rates over four years at the Children’s Healthcare of Atlanta using a sequential crossover design. Factors such as the proportion of patients receiving the intervention, efficacy in vaccine administration, clinician adoption, cost, and sustainability were evaluated to measure the intervention feasibility and impact.

Analysis of over 46,000 eligible hospitalizations found that all three CDS strategies significantly improved vaccine rates among hospitalized children across four flu seasons. The influenza vaccine order set was the most successful, followed by the conditional discharge alert, and finally the vaccine status notifications. Vaccination rates did decline in both the control and intervention groups over time, potentially due to the decreasing effectiveness of CDS, or external factors such as provider challenges and vaccine hesitancy during the COVID-19 pandemic. Future studies should examine the combination of CDS with other implementation strategies to increase the benefits and support of this vulnerable population.