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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Healthcare workers (HCW) with influenza may infect patients; transmissibility can begin one day before symptom onset and up to 50% of infections may be subclinical. Seasonal influenza vaccine is 70-90% effective in preventing infection in healthy adults and reduces absenteeism. ACIP, SHEA, and IDSA have recommended that all HCW be immunized as an 80% vaccination rate may provide “herd” immunity in a hospital setting. Previous seasonal influenza vaccination rates were < 60% for University Health System (UHS), a 600 bed tertiary care hospital with a solid organ transplant program, hematology oncology unit, 16 outpatient clinics, and ED with >70,000 visits per year.
Objective: Use quality improvement (QI) tools to improve the employee flu vaccination rate to 80% or more at UHS for the 2009-2010 influenza season.
Methods: Prior flu vaccination rates were reviewed with the UHS Board, who supported universal voluntary vaccination of employees. A QI team including occupational health, infection prevention, corporate communications, nursing, medical staff leadership, residency program leadership and quality management was chartered by UHS leadership and met weekly. QI tools used: brainstorming, force-field analysis, cause-effect diagram, process flow chart and Gantt chart.
Results: Interventions included distribution of flu vaccine kits to UHS ward and clinic units, Grand Rounds presentations for major departments, campaign announcement to unit directors, development of a UHS influenza website with information and a flu blog, screensaver reminders, employee emails, and phone messages. A color-coded dashboard displaying vaccination rates by UHS department was posted on the UHS intranet. For the 2008-2009 season (Oct-March) prior to the intervention, the vaccination rate was 58% (2989/5496 employees vaccinated). Beginning September 2009, 90% (5010 /5569) active UHS employees were contacted with an influenza vaccination form. Among those contacted, 4147 (83%) received vaccination. 863 (17%) declined vaccination. Most common reasons for declination were: concern about getting flu (124; 14%) or side effects (77; 9%) and doubt of effectiveness (62; 7%). Medical contraindication was uncommon (47; 5%) . After the QI team interventions (September-November 2009), vaccination rate increased to 74.5%, a 17% increase from the pre-intervention period (OR 2.4, 95% CI 2.2-2.6, p: <0.01).
Conclusions: A QI team-based, interprofessional and multidisciplinary approach increased the rate of seasonal vaccination. The interventions and increased availability of vaccines enhanced staff awareness. Weekly dashboards on the UHS intranet web site helped unit directors track vaccination rates. Support of executive leadership, multiple communication channels, and audit-feedback were critical success factors in increasing the vaccination rate.
Objective: Use quality improvement (QI) tools to improve the employee flu vaccination rate to 80% or more at UHS for the 2009-2010 influenza season.
Methods: Prior flu vaccination rates were reviewed with the UHS Board, who supported universal voluntary vaccination of employees. A QI team including occupational health, infection prevention, corporate communications, nursing, medical staff leadership, residency program leadership and quality management was chartered by UHS leadership and met weekly. QI tools used: brainstorming, force-field analysis, cause-effect diagram, process flow chart and Gantt chart.
Results: Interventions included distribution of flu vaccine kits to UHS ward and clinic units, Grand Rounds presentations for major departments, campaign announcement to unit directors, development of a UHS influenza website with information and a flu blog, screensaver reminders, employee emails, and phone messages. A color-coded dashboard displaying vaccination rates by UHS department was posted on the UHS intranet. For the 2008-2009 season (Oct-March) prior to the intervention, the vaccination rate was 58% (2989/5496 employees vaccinated). Beginning September 2009, 90% (5010 /5569) active UHS employees were contacted with an influenza vaccination form. Among those contacted, 4147 (83%) received vaccination. 863 (17%) declined vaccination. Most common reasons for declination were: concern about getting flu (124; 14%) or side effects (77; 9%) and doubt of effectiveness (62; 7%). Medical contraindication was uncommon (47; 5%) . After the QI team interventions (September-November 2009), vaccination rate increased to 74.5%, a 17% increase from the pre-intervention period (OR 2.4, 95% CI 2.2-2.6, p: <0.01).
Conclusions: A QI team-based, interprofessional and multidisciplinary approach increased the rate of seasonal vaccination. The interventions and increased availability of vaccines enhanced staff awareness. Weekly dashboards on the UHS intranet web site helped unit directors track vaccination rates. Support of executive leadership, multiple communication channels, and audit-feedback were critical success factors in increasing the vaccination rate.