TY - JOUR
T1 - An Electronic Health Record Alert for Inpatient Coronavirus Disease 2019 Vaccinations Increases Vaccination Ordering and Uncovers Workflow Inefficiencies
AU - Black, Kameron Collin
AU - Snyder, Nicole Ashley
AU - Zhou, Mengyu
AU - Zhu, Zhen
AU - Uptegraft, Colby
AU - Chintalapani, Ani
AU - Orwoll, Benjamin
N1 - Publisher Copyright:
© 2024. Thieme. All rights reserved.
PY - 2023/7/3
Y1 - 2023/7/3
N2 - Background: Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. Objective: Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. Methods: This was a quasiexperimental pre-post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation. Results: Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39-4.74, p < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23-2.13, p < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70-3.82, p < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73-1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital. Conclusion: Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.
AB - Background: Despite mortality benefits, only 19.9% of U.S. adults are fully vaccinated against the coronavirus disease 2019 (COVID-19). The inpatient setting is an opportune environment to update vaccinations, and inpatient electronic health record (EHR) alerts have been shown to increase vaccination rates. Objective: Our objective was to evaluate whether an EHR alert could increase COVID-19 vaccinations in eligible hospitalized adults by prompting providers to order the vaccine. Methods: This was a quasiexperimental pre-post-interventional design study at an academic and community hospital in the western United States between 1 January, 2021 and 31 October, 2021. Inclusion criteria were unvaccinated hospitalized adults. A soft-stop, interruptive EHR alert prompted providers to order COVID-19 vaccines for those with an expected discharge date within 48 hours and interest in vaccination. The outcome measured was the proportion of all eligible patients for whom vaccines were ordered and administered before and after alert implementation. Results: Vaccine ordering rates increased from 4.0 to 13.0% at the academic hospital (odds ratio [OR]: 4.01, 95% confidence interval [CI]: 3.39-4.74, p < 0.001) and from 7.4 to 11.6% at the community hospital (OR: 1.62, 95% CI: 1.23-2.13, p < 0.001) after alert implementation. Administration increased postalert from 3.6 to 12.7% at the academic hospital (OR: 3.21, 95% CI: 2.70-3.82, p < 0.001) but was unchanged at the community hospital, 6.7 to 6.7% (OR: 0.99, 95% CI: 0.73-1.37, p = 0.994). Further analysis revealed infrequent vaccine availability at the community hospital. Conclusion: Vaccine ordering rates improved at both sites after alert implementation. Vaccine administration rates, however, only improved at the academic hospital, likely due in part to vaccine dispensation inefficiency at the community hospital. This study demonstrates the potential impact of complex workflow patterns on new EHR alert success and provides a rationale for subsequent qualitative workflow analysis with alert implementation.
KW - COVID-19
KW - academic hospital
KW - clinical decision support
KW - computerized soft-stop
KW - decision support systems
KW - electronic health records
KW - vaccination
UR - http://www.scopus.com/inward/record.url?scp=85187202399&partnerID=8YFLogxK
U2 - 10.1055/a-2250-6305
DO - 10.1055/a-2250-6305
M3 - Article
C2 - 38253337
AN - SCOPUS:85187202399
SN - 1869-0327
VL - 15
SP - 192
EP - 198
JO - Applied Clinical Informatics
JF - Applied Clinical Informatics
IS - 1
ER -