71 Implementation of an Ed-Based COVID-19 Vaccine Program

Maloney, G.; Carrol, B.; Wenzell, R.

Study Objectives: Vaccinating eligible high-risk patients, against the COVID-19 virus is a public health priority. The Veterans Health Administration serves as the nation’s largest safety-net health system, serving a population with both a high level of medical comorbidities and socioeconomic factors that can create barriers to care. To expand access to vaccines beyond the regularly scheduled vaccine clinic hours, an ED-based COVID-19 vaccine program was developed. at our facility. Methods: The setting is a 27,000 visit Veterans Health Administration ED that is also an ACEP Level 1 Geriatric ED. The existing vaccine program used the Pfizer vaccine, with appointments scheduled through a vaccine clinic that operated 7 days a week. With the approval of the single dose Janssen vaccine, to expand our outreach and vaccinate more patients, an ED-based vaccination program was developed. At triage, the triage nurse reviewed the charts of all stable (ESI 3-5) patients to determine if they had already received at least one dose of vaccine, or were scheduled to receive a dose of vaccine in the outpatient clinic. If not, then a flag would be placed on the tracking board to alert the provider seeing the patient that they were a candidate for the single-dose Janssen vaccine. The provider would then screen for contraindications and obtain consent for the vaccine. Only patients who were checking into the ED for another complaint were screened;the ED was not advertised as an alternative site for vaccine-only visits. Results: From initiation of the program on March 16, 2021, until the pause on use of the Janssen vaccine on April 13, a total of 27 patients received the vaccine. A total of 37 patients were screened as eligible for the vaccine. For those not receiving the vaccine, 6 had documentation of a reason;1 had a contraindication, and 5 refused the vaccine. 4/27 were female (14.8%);female patients comprise 7% of our ED volume. The average age of the female patients was 37 (range, 24-55). 23/27 (85.2%) were male;their average age was 57 (range, 39-69). 15/27 (55.5%) patients resided in an urban area. 6/27 (22%) lived in areas classified as rural. 8/27 patients (30%) were Black, 3/27 (11%) were latino, and 16/27 (59%) were white. There were no documented allergic reactions or other immediate adverse events reported for any of the ED-vaccinated patients. Conclusion: We report preliminary results for an ED-based COVID vaccine program using the single-dose JAndJ/Janssen vaccine. Female patients represented a higher percentage of those receiving the vaccine than represented by their percentage of our total ED visits. Further research needs to be done into those who refuse the vaccine, as well as interventions to reduce the number of missed opportunities (patients who were flagged on the tracking board but did not receive further screening for vaccine eligibility by the ED provider). Adverse events were not reported in our cohort.