BACKGROUND:
Few, if any, simple interventions increase vaccination coverage among low income adults to influenza, pneumococcal (PPV), and hepatitis B (HBV) vaccines.

OBJECTIVE:
To determine the extent to which emergency department (ED) visits could be used to increase vaccination coverage.

METHOD:
Convenience sample of 104 uninsured or Medicaid patients between 18 and 64 years with non-life threatening health problems in an ED in Louisiana was assessed. Paramedical staff asked patients questions based on ACIP recommendations that were reworded into a fourth grade reading level. If vaccine was indicated (patient responded yes to a recommendation statement and was not up-to-date (UTD)), the patient was offered educational material, and randomized to free vaccination during their ED visit (ED group) or two weeks later in a vaccination clinic (VC group).

RESULT:
Influenza vaccine was recommended for 72 (71%) of whom 7 (10%) were UTD. Of those not UTD, 64% randomized to ED were vaccinated versus 16% randomized to VC (P=0.0001). PPV was recommended for 36 (35%) of whom 9 (25%) were UTD. Of those not UTD, 45% were vaccinated in the ED versus 13% referred to the VC (P=0.05). Hepatitis B vaccine was recommended for 42 (40%) of whom 10 (24%) were UTD. Of those not UTD, 57% were vaccinated in the ED versus 28% randomized to VC (P=0.09).

CONCLUSION:
High levels of coverage for flu, PPV, and HBV were achieved in the ED group following an assessment and educational intervention. Significantly more of those randomized to ED received vaccine than those randomized to VC. Assessment and vaccination of adult patients during an ED visit may be an opportunity to vaccinate patients who have fallen through societies other safety nets.

LEARNING OBJECTIVES:
State the approximate proportion of ED patients agree to receive ACIP recommended vaccinations in the ED and what proportion are vaccinated when they are referred to another site for vaccination.