Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Ian Schwartz

Subject Area(s)



Influenza and pneumococcal disease represent a substantial cause of morbidity and mortality, which is largely preventable with routine immunizations. The Emergency Department (ED) represents a unique avenue to reach a disproportionally high risk and under-vaccinated population. ED based programs for influenza and pneumococcal vaccinations are likely to be both feasible and cost effective, yet the administration of these vaccines in the ED is an uncommon practice. Little is known about the true prevalence of current ED based adult vaccination, as well as the attitudes of ED medical directors towards implementing these vaccination programs. This study used an electronic survey to study the prevalence of routine adult vaccination practices occurring in the ED and the perceptions of ED directors regarding potential barriers preventing effective ED vaccination programs. The survey was completed by 104 ED directors throughout the northeastern US, at a mixture of rural, suburban, and urban hospitals, as well as academic and non-academic hospitals. Of the 104 hospitals 45 (43%) and 36 (35%) ED directors indicate their ED provides some amount of influenza and pneumococcal vaccinations respectively, but these estimates become 16.3% and 5.8% respectively when more conservative criteria are applied. Thirty-seven ED directors (36%) indicated supporting the practice of providing routine adult immunizations in the ED. The identified barriers to ED based vaccination programs are as follows: time pressure on nurses, patients inability to provide an accurate vaccination history, lack of needed resources to store vaccinations, time pressure on ED physicians, lack of an ED vaccination protocol, belief that vaccination is the sole job of primary care physicians, and the prohibitively high cost of a vaccination program. On average, time pressure on nurses was identified as the most significant barrier to ED vaccination. It is likely that uniquely tailored community level solutions will be the most successful to solve the problem of under vaccination. The role of the ED in these programs will likely be highly variable.