title: A care pathway to boost influenza vaccination rates among inpatients with acute ischemic stroke and transient ischemic attack.
abstract: BACKGROUND
  Although influenza-related morbidity and mortality is high, and influenza can be a trigger for recurrent stroke, only about half of stroke survivors receive yearly influenza vaccination. Identifying new avenues through which to optimize influenza vaccination among stroke survivors is a public health need. We assessed the feasibility of integrating influenza vaccination into routine inpatient stroke care.
  
  
  METHODS
  We designed a quality improvement project incorporating influenza vaccination into care administered to hospitalized patients with ischemic stroke and transient ischemic attack that included a standardized order and discharge checklist. Data were then prospectively collected on consecutively encountered patients with ischemic stroke and transient ischemic attack admitted to a university hospital stroke service during the influenza season of October 2007 to February 2008. Successful influenza treatment use was based on optimal rather than actual treatment, with credit for optimal treatment given if an acceptable reason for nonadministration of the vaccine was documented.
  
  
  RESULTS
  Of 103 patients admitted during the study period, 75 (73%) were eligible for influenza vaccination (mean age 72.8 years; 51% women). Among vaccination-eligible patients, 65 (87%) received optimal influenza vaccination treatment, whereas 14 (21%) actually received the vaccination during hospitalization. Leading reason (90%) for suboptimal influenza vaccination treatment among eligible patients was that the vaccination was inadvertently not ordered on admission or at discharge.
  
  
  CONCLUSIONS
  Influenza vaccination can be systematically incorporated into stroke hospitalization and may be a viable avenue for promptly enhancing short-term clinical outcomes among hospitalized patients with stroke during peak influenza season.
authors.affiliation: Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Norma
authors.initials: N
authors.lastname: McNair
authors.forename: Sandra
authors.initials: S
authors.lastname: Pineda
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000628:therapy; D019091:Critical Pathways; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D007297:Inpatients; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D012621:Seasons; D020521:Stroke / Q000209:etiology / Q000628:therapy*
chemical_list: D007252:Influenza Vaccines