Influenza vaccination rates for hospitalised patients: a multiyear quality improvement effort.

Background: Influenza vaccination is the most effective method for preventing influenza virus infection. Adult hospitalised patients form a particularly high-risk group for severe influenza given their advanced age and comorbidities. We sought to improve the influenza vaccination rates of hospitalised patients at the White River Junction Veterans Affairs Medical Center.

Methods: The improvement effort started in 2007 when our baseline vaccination rate was about 60%. An interprofessional team analysed the influenza vaccination process for hospitalised patients. During the course of six influenza seasons, eight Plan-Do-Study-Act cycles were used including a hospital-wide flu campaign, embedded orders in the electronic medical record (EMR) to facilitate ordering vaccinations by providers, daily reminders from ward clerks and standing orders for influenza vaccination on discharge. The measure was the monthly percentage of patients discharged from the hospital with an up-to-date influenza vaccination.

Results: The percentage of veterans discharged with an up-to-date influenza vaccination increased to over 80% in February 2009 and has remained high.

Conclusions: Although we are confident that our local efforts helped to improve the vaccination rate, external factors such as the 2009 H1N1 pandemic and universal vaccination may have primed our system to respond more readily to the implemented changes. Understanding all of the relevant factors that lead to vaccination uptake can be applied to future hospital influenza vaccination campaigns. In addition, our work demonstrates that an interprofessional approach is still required to apply the functionality of the EMR effectively.