Newsletters

POSTED: December 17th, 2021
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, November/December 2021,

Written by Kevin O’Rourke, MD, FACEP

Whenever anyone approaches me about rolling out a new program in the hospital, they usually say, “I think the Emergency Department (ED) would be the perfect place to do this.”  I take a deep breath and happily schedule the meeting to discuss as we often have different definitions of “perfect”. 

As the pace of vaccinations in the vaccine clinic started to slow in April, the ED did feel like the perfect place to roll out a new program for this once in a generation challenge.  The state of Missouri supplied us with 200 doses of Janssen vaccine to deliver to patients in the ED.  On April 12^th, a group of key stakeholders met to discuss how we would vaccinate patients in the ED with plans to start vaccinating patients the next day.  On April 13^th, the FDA paused the use of the J&J vaccine out of an abundance of caution.  We spent the next two weeks waiting for guidance from the FDA and CDC on the J&J vaccine and figuring out a process for using the Pfizer vaccine.  On April 28^th, we began the program again and vaccinated six patients with their first dose of the Pfizer vaccine.

In order to notify patients that they can get vaccinated in the ED, they are met with multiple signs encouraging them to get vaccinated from the moment they reach registration.  All ED staff are encouraged and empowered to ask their patients about getting vaccinated.  We have sent out education materials to the medical staff and posted communication about talking to your patients about the vaccine and addressing vaccine hesitancy.  We made packets with vaccine consents, vaccination cards and vaccine fact sheets to give to patients. 

When a patient consents to getting vaccinated, an order is placed in the computer for the vaccine.  The pharmacy prepares the vaccine and they let the ED team know when the beyond use time is.  When an order is placed for a vaccine, the provider also orders a consult for the second dose.  This order populates a queue in our call center and they reach out to the patient to schedule their second dose.  For patients without phones, we give them a date to show up 3 weeks from their visit to receive their second dose, and no appointment is necessary.  We also have a pop-up in the EMR that will alert providers when someone has an encounter anywhere in our system the 21^st day after their first dose of Pfizer.  We have been able to catch some people for their second dose due to this alert.  Some days are more successful than others and some patients are more willing than others, but overall the process has worked well.  We currently offer any of the three vaccines and have started to offer third doses to interested patients.

As of today, 510 people have received their covid vaccine in the ED.  We are happy that 315 people have completed their vaccine series and we continue to reach out to other patients to encourage them to get their second shots. 

Click here to view ACEP’s resources for implementation of vaccine programs in the ED.