“ After mitigation measures went into place , cases of influenza virtually disappeared ,” she says . “ But our lockdown is not as strict . So a lot is still unknown .”
One thing that is known : The best way to mitigate the spread of the flu is vaccination , the more the better . And Dr . Rao has been studying that for a long time .
1 . Found opportunity
Kids get hospitalized with influenza every season . At Children ’ s Hospital Colorado between 2010 and 2014 , about 61 % of them weren ’ t vaccinated . Dr . Rao wanted to know how many of those had missed an opportunity to get vaccinated that season , whether through a clinic setting , an emergency department visit or a prior hospitalization . The answer : 42 % of them — meaning more than 40 % of those hospitalizations might have been prevented ( 1 ).
2 . Perceived perceptions
If hospitals could kill two proverbial birds with one stone and vaccinate a child while they were there anyway , then why wasn ’ t it happening ? Dr . Rao and team surveyed both parents and providers . It turned out most parents would agree to a flu vaccination during a hospitalization if it were offered . Many providers , however , perceived that parents would refuse a vaccination due to their child ’ s illness and misconceptions of the vaccine , although many also reported that they just didn ’ t think to offer it ( 2 ).
3 . Evaluating interventions
Armed with that insight , Dr . Rao and her team set out to explore how to increase the rate at which providers offered vaccinations to eligible hospitalized kids older than 6 months . They compared three groups : one group receiving provider reminders including prompts in the electronic health record and weekly emails indicating inpatient immunization status ; another group receiving vaccine education for families ; and a control group . The providertargeted intervention was most effective , increasing vaccination orders for eligible patients to 52 %. The family education group saw orders at 30 % and the control group at 25 % ( 3 ).
4 . Exerting inFLUence
Dr . Rao ’ s team continue to refine those efforts through Children ’ s Colorado ’ s Be InFLUential campaign ( 4 ), which wraps providers , nurses , families , staff champions and robust data analytics into the effort . “ We ’ ve made a lot of it automated and built in to make it an easy process to order the vaccine ,” says Dr . Rao . “ We review the data and work on ways to improve month to month . We ’ ve been thrilled to see how our efforts have blossomed .”
Last season , Children ’ s Colorado saw eligible medical inpatients receiving vaccines at a rate of 83 %. •
1 . Rao S , Williams JT , Torok MR , Cunningham MA , Glodè MP , Wilson KM . Missed Opportunities for Influenza Vaccination Among Hospitalized Children With Influenza at a Tertiary Care Facility . Hosp Pediatr . 2016 Sep ; 6 ( 9 ): 513-9 .
2 . Rao S , Fischman V , Moss A , Ziniel SI , Torok MR , McNeely H , Hyman D , Wilson KM , Dempsey AF . Exploring provider and parental perceptions to influenza vaccination in the inpatient setting . Influenza Other Respir Viruses . 2018 May ; 12 ( 3 ): 416-420 .
3 . Rao S , Fischman V , Kaplan DW , Wilson KM , Hyman D . Evaluating Interventions to Increase Influenza Vaccination Rates among Pediatric Inpatients . Pediatr Qual Saf . 2018 Sep 28 ; 3 ( 5 ): e102 .
4 . Rao S , Ziniel SI , Khan I , Dempsey A . Be inFLUential : Evaluation of a multifaceted intervention to increase influenza vaccination rates among pediatric inpatients . Vaccine . 2020 Feb 5 ; 38 ( 6 ): 1370-1377 .
“ We ’ ve made a lot of it automated and built in to make it an easy process to order the vaccine . We ’ ve been thrilled to see how our efforts have blossomed .”
SUCHITRA RAO , MBBS , MSCS
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