An emergency department-based pneumococcal vaccination program could save money and lives.
OBJECTIVE
Pneumococcal vaccination (PV) rates for eligible emergency department patients are less than 25%. This study determines the potential effect of an ED-based pneumococcal vaccination program in preventing pneumococcal bacteremia (PB) in high-risk patients.


METHODS
In a retrospective observational study, hospital records of 188 consecutive adults (>/=18 years old) with PB were reviewed to determine how many were treated in the ED from 1 to 72 months before their admission for bacteremia. Potential cost savings and mortality reductions from an ED-based PV program were calculated assuming PV prevents 65% of bacteremic episodes. A retrospective review of 10,650 ED charts determined the percentage of patients with PV indications and the relative frequency of indications.


RESULTS
One hundred four (55%) of the 188 patients with PB were seen in the ED less than or equal to 72 months before their admission for PB, and 91 (88%) of the 104 had indications for PV. These 91 patients had been evaluated in the ED an average of 3.4 times per patient during this 72-month period. Nine patients (10%) died before discharge. Mean hospital stay for the 82 survivors was 11.2 days. Of 10,650 ED charts reviewed, 2,011 (19%) had documented PV indications. Most prevalent PV indications were age 65 years or older (851 patients, 42%), diabetes mellitus (697, 35%), malignancy (248, 12%), chronic renal failure (228, 11%), and immunosuppression (221, 11%). Estimated cost savings ranged from $168,940 to $427,380.


CONCLUSIONS
ED-based PV programs would result in considerable cost savings and decreased mortality.
Stack
S J
SJ
Department of Emergency Medicine, Division of Infectious Diseases, The Ohio State University College of Medicine and Public Health, Columbus, OH.
Martin
D R
DR
Plouffe
J F
JF
D000046:Academic Medical Centers / Q000191:economics; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000191:economics / Q000517:prevention & control*; D001428:Bacterial Vaccines / Q000008:administration & dosage / Q000191:economics*; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000191:economics / Q000458:organization & administration*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000191:economics / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies
D001428:Bacterial Vaccines; D022242:Pneumococcal Vaccines