Flu-Vaccine Education in the Emergency Department Helps People get their Shot

People who don’t regularly see a primary-care physician, including those from African American and Latinx communities, are more likely to die or need hospitalization from a bout of influenza. They also experience more barriers to vaccine education and care. A new study publishing in the journal NEJM Evidence shows how patient education during an emergency department visit can effectively improve flu-vaccination rates.

“In our earlier study, we saw great success in educating patients about the COVID-19 vaccine during their ED visit – brief messaging videos and educational flyers led to significantly higher COVID-19 vaccine acceptance and update,” says Kristin Rising, MD, executive director of the Center for Connected Care and professor of emergency medicine at Thomas Jefferson University. “This study builds on that work, to explore simple measures that can increase flu-vaccine uptake in our communities. Especially when the emergency department is the primary and sometimes only access point for health care.”

The study was a cluster randomized controlled trial, a type of study that offers a gold standard of evidence, enrolling a total of 767 participants from six emergency departments in five US cities. Dr. Rising collaborated with colleague Dr. Efrat Kean at Thomas Jefferson University and study leader, Robert Rodriguez, MD, at the University of California, San Francisco, among others, to develop educational materials consisting of a video, a one-page flyer, and a scripted message delivered by a medical professional in Spanish and English.

The participants were 46% female, 36% African American and 21% Latinx, 12% didn’t have health insurance and 32% were without a primary care physician. All of the participants were randomized to one of three groups. One group of ED patients received the developed materials, another group was simply asked if they wanted the flu vaccine, and a third group received no additional discussion or education about the vaccine. The researchers then monitored the medical records of the participants for 30 days and recorded when a flu shot was recorded in their electronic health record or via a follow-up phone call at 30 days.

“We took care to design the materials in a way that would put participants at ease,” says Dr. Rising, “We made sure the messages were delivered in both Spanish and English, and that the videos featured physicians who matched the racial characteristics of the participants. For example, Black patients saw a video featuring Black doctors and medical experts talking about the vaccine.”

When researchers compared the three groups, it became evident that the group that received the video education material was more likely to get a flu shot in the 30 days after their ED visit than the other groups. Specifically, 41% of participants who received the video education then went on to get vaccinated. Interestingly, 32% of participants who were simply asked whether they were open to getting a flu vaccine also followed up with a shot. Only 15% of patients in the group that received no additional messaging about flu got vaccinated.

“The fact that simply mentioning vaccination had such a positive impact on future vaccination rates among our sample is incredible, and makes a strong case for incorporating vaccine messaging into emergency department workflows,” explains Dr. Kean, assistant professor of emergency medicine at Thomas Jefferson University. As such, future work of the team is focused on identifying best practices for incorporating this messaging into routine emergency department care processes.

Author disclosures and other supplementary materials are available at evidence.nejm.org.

Article reference: Robert M. Rodriguez, Stephanie A. Eucker, Zubaid Rafique, Graham Nichol, Melanie F. Molina, Efrat Kean, Kelli N. O’Laughlin, Sarah K. Bezek, Karina Goicochea, James Ford, Vidya Eswaran, Dana Morse, Jaran White, Mireya I. Arreguin, Lindsey Shughart, Cecilia Lara Chavez, Dave V. Glidden, and Kristin L. Rising, “Promotion of Influenza Vaccination in the Emergency Department,” NEJM Evidence, DOI: 10.1056/EVIDoa2300197, 2024.

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