A care pathway to boost influenza vaccination rates among inpatients with acute ischemic stroke and transient ischemic attack.
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.
Ovbiagele
Bruce
B
Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA 90095, USA. Ovibes@mednet.ucla.edu
McNair
Norma
N
Pineda
Sandra
S
Liebeskind
David S
DS
Ali
Latisha K
LK
Saver
Jeffrey L
JL
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*
D007252:Influenza Vaccines