Implementation of a COVID-19 Vaccine Emergency Department Education Program for Underserved Communities

Background The COVID-19 pandemic has provided an opportunity for significant reflection on our public health response as providers. Throughout the past two years, we learned that administration of COVID-19 vaccines, rapidly and widely across all communities, has been key to halting the spread of the virus. One significant challenge in promoting a large-scale immunization program is the threat of vaccine hesitancy. A general mistrust in healthcare providers exists across the country, especially in underrepresented minority (URM) communities. Objective This study aims to determine reasons for vaccine hesitancy in an urban emergency department and to provide targeted education on the safety and efficacy of the COVID-19 vaccines to patients. Methods An interprofessional quality improvement team was assembled to develop an educational intervention addressing COVID-19 vaccine safety for vaccine-eligible patients receiving treatment in the emergency department at an urban community hospital where over 70% of patients identify as URM. A survey was conducted to elucidate patients' concerns surrounding the COVID-19 vaccine. Upon completion of the survey, up-to-date safety information and education targeting their surveyed concerns were provided by trained medical students. A follow-up survey was conducted to assess the impact of education on patients' attitudes toward the vaccine. Surveys were developed using standardized scoring systems from the Oxford coronavirus explanations, attitudes, and narratives survey (OCEANS) II study and the Kaiser Foundation. Hesitancy scores before and after education were tabulated to assess the effectiveness of targeted education in improving vaccine hesitancy. Results Patients cited a variety of concerns surrounding the COVID-19 vaccine. The three most common reasons for declining vaccines were potential side effects (67.3% were concerned or extremely concerned), the belief that COVID-19 vaccines are neither effective nor safe (64.5% were concerned to extremely concerned), and the risk of developing COVID-19 infection from the vaccine itself (38.8% were concerned to extremely concerned). This information was used to address these concerns directly with patients, answer questions, clarify information, and encourage patients to get vaccinated. Through this education program, vaccine hesitancy scores improved by an average of 29% indicating an increased likelihood of patients who would get vaccinated in the future. Of patients receiving education, 38% agreed to sign up for a vaccine appointment during the intervention. Conclusion The emergency department often serves vulnerable patient populations. As such, its role in public health in these communities cannot be underestimated. This quality improvement project is a novel method that can be used to develop and implement public health education programs to address specific community needs in the emergency department. These results show that a multidisciplinary healthcare team can provide a measurable change in attitudes about vaccine safety with directed education in the emergency department that can help address vaccine hesitancy in the future.

The effect of nalbuphine on the common bile duct pressure

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A method of controlling hemorrhage for resection of massive hemangiomas of the liver

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Subclavian thrombosis following hockey injuries

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Bilateral vocal cord paralysis. A complication of percutaneous cannulation of the internal jugular veins

A severe complication resulted from internal jugular cannulation. An obese patient had hematomas after bilateral attempts. The first cannulation (on the right) was successful after many tries; the second (on the left) was not. The patient was hoarse after the first attempt; more so and dyspneic after the second. Laryngoscopic examination showed paralysis of the vocal cords. Tracheostomy was done. Two weeks later, the cords were seen to move normally. The tracheostomy was removed, and recovery was uneventful.

Serendipitous passage of a common duct stone following ampullary cannulation

A transduodenal endoscopic pancreatocholangiography dislodged a distal common duct stone. The conclusion that the stone was disimpacted by the manipulation was reached by (1) demonstration of a negative shadow representing a stone in the distal part of the common duct on roentgenograms following injection of contrast material after successful ampullary cannulation, (2) the clinical sequence of events that followed ampullary cannulation, and (3) the operative finding of a grossly dilated common duct without the presence of a stone and normal intraoperative and postoperative T-tube cholangiograms.