title: Quality improvement in critical access hospitals: addressing immunizations prior to discharge.
abstract: BACKGROUND
  Many patients hospitalized in critical access hospitals (CAHs) are at high risk for influenza and pneumonia. These hospitalizations may represent a missed opportunity to address immunizations. Addressing these missed immunizations could provide an opportunity for CAHs to gain practical experience in data-driven quality improvement.
  
  
  OBJECTIVE
  To improve documentation and delivery of influenza and pneumococcal immunizations prior to hospital discharge and provide CAHs with quality improvement experience.
  
  
  METHODS
  We recruited 17 CAHs in Kansas to participate in a rapid-cycle quality improvement project to address inpatient immunizations. Each hospital identified patient discharges on a monthly basis and abstracted medical records to see if the patient's immunization status had been assessed and if patients had been vaccinated prior to discharge.
  
  
  RESULTS
  Documentation of influenza immunization status improved from 17% of admissions at baseline to 62% at follow-up (P < 0.001). Documentation of pneumococcal immunization status increased from 36% at baseline to 51% at follow-up (P < 0.001). Documentation of immunizations was significantly higher among the 8 hospitals that developed standard charting forms for recording immunization status (P < 0.01). Despite improved documentation of immunization status, at remeasurement only 3.4% received an influenza vaccination and 1.3% received a pneumococcal vaccination prior to discharge.
  
  
  CONCLUSIONS
  Critical access hospitals can effectively participate in quality improvement activities, but increased involvement of medical staff or standing immunization orders may be needed to improve actual vaccine administration prior to discharge.
authors.affiliation: Department of Preventive Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7313, USA. eellerbe@kumc.edu
authors.forename: Edward F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: Bonnie
authors.initials: B
authors.lastname: Totten
authors.forename: Samuel
authors.initials: S
authors.lastname: Markello
authors.forename: Kelly
authors.initials: K
authors.lastname: Patterson
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Sipe
authors.forename: Chris
authors.initials: C
authors.lastname: Tilden
mesh_terms: D004282:Documentation / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006285:Health Planning; D006297:Health Services Accessibility / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D007252:Influenza Vaccines / Q000627:therapeutic use; D007615:Kansas; D010351:Patient Discharge; D022242:Pneumococcal Vaccines / Q000627:therapeutic use; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines