Pediatric COVID-19 Vaccination in the Inpatient Setting.

BACKGROUND AND OBJECTIVES: The inpatient setting is often underutilized as a venue for providing pediatric vaccines. During the 2019 novel coronavirus (COVID-19) pandemic, our hospital began a vaccination program to provide access to COVID-19 vaccines for eligible pediatric inpatients. Our objective was to describe the establishment and assess the impact of a COVID-19 vaccination program for pediatric inpatients. METHODS: All admitted patients were screened for eligibility and interest in inpatient COVID-19 vaccination upon admission from April 27, 2021 until February 12, 2022. For those eligible for vaccination, their interest was recorded and shared with the clinical team. The clinical team completed education and/or vaccination depending on individual case. Interest in inpatient vaccination and ultimate receipt of a vaccine was recorded and analyzed. RESULTS: During the study period, 1615 patients were eligible for inpatient vaccination and 1601 had their interest recorded on hospital admission. Twenty-one percent of these patients were interested, 50% declined, and 28% were unsure. Twenty-nine percent of those initially interested were given vaccine by the clinical team before discharge. Six percent of patients who were unsure and 2% of those who declined vaccine on admission were vaccinated before discharge. CONCLUSIONS: The inpatient setting can be an important venue to allow for education and discussion regarding pediatric COVID-19 vaccine and to improve access to vaccination for a traditionally under-vaccinated population. Challenges remain with consistent vaccine administration even for interested pediatric inpatients.

Late Rescue Collaborative: Reducing Non-ICU Arrests.

OBJECTIVE: To reduce the frequency of non-ICU arrests through the implementation of an intramural collaborative focused on patient deterioration. DESIGN: Prospective quality improvement project. SETTING: Single-center, free-standing, tertiary children's hospital. PATIENTS: All patients admitted to acute care units. INTERVENTIONS: The Late Rescue Collaborative was formed in 2014 to monitor compliance with hospital escalation protocols and evaluate episodes of patient deterioration. The collaborative is a multidisciplinary team of physicians, nurses, and respiratory care providers. Three monthly meetings occur: 1) individual acute care unit-based meetings to evaluate trends and performance; 2) hospital-wide multidisciplinary whole group meetings to review hospital trends in deterioration and share lessons learned; and 3) steering committee to determine areas of focus. Based on these three meetings, unit- and hospital-based interventions have been put in place to improve recognition of deterioration and promote early rescue. MEASUREMENTS AND MAIN RESULTS: Rates of rapid response team activations, unplanned transfers, and non-ICU arrest are reported. Non-ICU arrest rates fell from a baseline of 0.31 per 1,000 non-ICU patient days to a new centerline of 0.11 and sustained for 36 months. Days between non-ICU arrests increased from a baseline of 15.5 days in year 2014 to a new centerline of 61.5 days and sustained for 37 months. Mortality following non-ICU arrests fell from four in 2014 and 2015 to zero in years 2016-2018. CONCLUSION: The Late Rescue Collaborative is an effective tool to improve patient safety by reducing non-ICU arrests.