A Computerized Pneumococcal Vaccination Reminder System in the Adult Emergency Department

Abstract

Preventive care measures including vaccinations are underutilized. The Emergency Department (ED) environment has been recommended to be a feasible environment to offer pneumococcal vaccination; however, the ED is a challenging setting for implementing a sustainable vaccination program. We designed, implemented, and evaluated a closed-loop, computerized reminder system in the ED that integrated four different computer systems. The computerized triage application screened patients for eligibility with information from the electronic patient record. The computerized provider order entry system reminded clinicians to order the vaccination for eligible patients, which was passed to the order tracker application. Documentation of vaccine administration was then added to the electronic patient record. During a two-month, prospective study 433 (51.9%) patients 65 years and older were up-to-date with pneumococcal vaccination, and 271 (32.5%) declined to receive the vaccine during their ED visit. From the physician prompts, 94 (11.2%) declined to order the vaccine; 37 (4.4%) patients received the vaccine. The computerized reminder system increased vaccination rate from 51.9% to 56.4 % (p < 0.01). The closed-loop informatics solution seems to be a feasible and sustainable model to increase vaccination rates in a challenging ED environment.