An emergency department-based pneumococcal vaccination program could save money and lives

Study objective: Pneumococcal vaccination (PV) rates for eligible emergency department patients are less than 25%. This study determines the potential effect of an ED-based pneumococcal vaccination program in preventing pneum ococcal bacteremia (PB) in high-risk patients. Methods: In a retrospective observational study, hospital records of 188 co nsecutive adults (greater than or equal to 18 years old) with PB were revie wed to determine how many were treated in the ED from 1 to 72 months before their admission for bacteremia. Potential cost savings and mortality reduc tions from an ED-based PV program were calculated assuming PV prevents 65% of bacteremic episodes. A retrospective review of 10,650 ED charts determin ed the percentage of patients with PV indications and the relative frequenc y of indications. Results: One hundred four (55%) of the 188 patients with PB were seen in th e ED less than or equal to 72 months before their admission for PB, and 91 (88%) of the 104 had indications for PV. These 91 patients had been evaluat ed in the ED an aver age of 3.4 times per patient during this 72-month peri od. Nine patients (10%) died before discharge. Mean hospital stay for the 8 2 survivors was 11.2 days. Of 10,650 ED charts reviewed, 2,011 (19%) had do cumented PV indications. Most prevalent PV indications were age 65 years or older (851 patients, 42%), diabetes mellitus (697, 35%), malignancy (248, 12%), chronic renal failure (228, 11%), and immunosuppression (221, 11%). E stimated cost savings ranged from $168,940 to $427,380. Conclusion: ED-based PV programs would result in considerable cost savings and decreased mortality.