INFLUENZA AND PNEUMOCOCCAL VACCINATION IN THE EMERGENCY DEPARTMENT - IS IT FEASIBLE

Objective: To assess the numbers of high-risk adult patients presentin g to the emergency department (ED) who have not been vaccinated agains t influenza or pneumococcal disease and whether emergency physicians a re willing or able to routinely provide vaccination. Design: A survey of patients in the ED considered to be at high risk for morbidity and mortality from influenza or pneumococcal disease; an anonymous, mail-b ack survey of emergency physicians. Setting: The ED of a university-af filiated hospital with an annual census of 50,000 patient visits. Part icipants: A convenience sample of adult patients visiting the ED for a ny complaint who fulfilled the American Thoracic Society and Centers f or Disease Control and Prevention requirements as a high-risk patient requiring vaccination with influenza or pneumococcal vaccine. The phys icians surveyed were identified from the membership role of the state chapter of the American College of Emergency Physicians. Measurements: 1) Influenza and pneumococcal vaccination rates for high-risk patient s presenting to an ED during influenza season; 2) reasons for lack of immunization; 3) patient willingness to be vaccinated in the ED; 4) va ccination practice patterns for ED physicians; and 5) reasons why ED p hysicians arc unwilling to give these vaccines. Results: 212 high-risk patients were surveyed. 57% and 75% of these patients reported not ha ving received the influenza vaccine and the pneumococcal vaccine, resp ectively. The main reasons for not being immunized included not being informed they needed it, a prior adverse reaction, and procrastination . Of the unvaccinated patients, 54% were willing to be vaccinated in t he ED. Of the surveyed ED physicians, 89% and 93% never or rarely gave influenza and pneumococcal vaccines, respectively. 51% of the ED phys icians were willing to give the vaccine. Unwillingness stemmed mainly from: 1) the perception that ED physicians are not primary care provid ers, 2) inadequate time or personnel; and 3) concerns about adverse re actions or medicolegal liability. Only 5% of the physicians reported o rganized case-finding mechanisms in their EDs. Conclusion: Significant numbers of high-risk patients who arc unimmunized against influenza a nd pneumococcal pneumonia present to the ED. There is hesitancy among ED physicians about assuming the primary care task of providing such i mmunizations. Any attempt to institute a large-scale vaccination progr am in an ED setting needs to be carefully planned in a way to involve primary care providers and to decrease ED physician concerns and reluc tance.