A Care Pathway to Boost Influenza Vaccination Rates among Inpatients with Acute Ischemic Stroke and Transient Ischemic Attack

Ovbiagele, Bruce; McNair, Norma; Pineda, Sandra; Liebeskind, David S.; Ali, Latisha K.; Saver, Jeffrey L.

doi:10.1016/j.jstrokecerebrovasdis.2008.08.002

« Previous Next »Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 1 , Pages 38-40, January 2009

A Care Pathway to Boost Influenza Vaccination Rates among Inpatients with Acute Ischemic Stroke and Transient Ischemic Attack

Bruce Ovbiagele, MD
- Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA
- Address correspondence to Bruce Ovbiagele, MD, University of California Los Angeles Stroke Center and Department of Neurology, 710 Westwood Plaza, Los Angeles, CA 90095.
Norma McNair, RN
- Department of Nursing, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA
Sandra Pineda, BS
- Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA
David S. Liebeskind, MD
- Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA
Latisha K. Ali, MD
- Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA
Jeffrey L. Saver, MD
- Department of Neurology, University of California Los Angeles Medical Center, Westwood Plaza, Los Angeles, CA

Received 25 June 2008; accepted 6 August 2008.

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.

Key Words: Influenza, vaccination, stroke, health services, outcomes