Use of Peer Comparison, Provider Education, and Electronic Medical Record Triggers to Increase Influenza Vaccination Rates in Hospitalized Children

BACKGROUND: The American Academy of Pediatrics recommends annual influenza vaccination for all children 6 months and older, yet only 59% of children nationally received the vaccine during the 2014–2016 influenza seasons. Of these, only 4% received the vaccine in a hospital setting. The goal of this quality improvement (QI) initiative was to increase influenza vaccination status at discharge at least twofold in children admitted to our hospital during the 2017–2018 influenza season compared with the 2016–2017 season.

METHODS: The QI initiative was conducted in the inpatient units at a tertiary care children’s hospital. Interventions included electronic medical record triggers, provider education, and peer comparison. The primary outcome measure was the percentage of children discharged from the hospital with at least 1 dose of the influenza vaccine received either at the hospital or before admission. Queries about the influenza vaccination status of children were used as a process measure. Length of stay was used as a balancing measure.

RESULTS: The percentage of hospitalized children discharged with at least 1 dose of the vaccine increased 4.7-fold during the QI initiative (46%) compared with baseline (10%). There was a fourfold increase in parental query about the influenza vaccination status of their children (68%) during the QI initiative compared with the baseline period (16%). No significant difference occurred in the median length of stay among patients admitted during the QI initiative versus the baseline period.

CONCLUSIONS: We increased influenza vaccination status among children admitted to our hospital using electronic medical record triggers, provider education, and peer comparison.