26 Implementation of a COVID-19 Vaccine Emergency Department Education Program for Underserved Communities: A Pilot Quality Improvement Project

Background: The COVID-19 pandemic has been one of the greatest modern health challenges to date. The administration of COVID-19 vaccines, rapidly and widely across all communities, is key to halting the spread of the virus. One significant challenge in promoting a large-scale immunization program is the threat of vaccine hesitancy, particularly in underrepresented minority communities (URM). Study Objective: This project aimed to assess reasons for local vaccine hesitancy in an urban emergency department (ED) and to provide targeted education on the safety and efficacy of the COVID-19 vaccines to patients. Methods: An interprofessional team was formed of medical students, physicians, social works, and community outreach coordinators to develop an educational intervention addressing COVID-19 vaccine safety for eligible patients receiving treatment in the ED at a urban academic affiliated community hospital with over 70% of patients coming from underserved URM backgrounds. A survey was conducted to elucidate their concerns surrounding the COVID-19 vaccine. Upon completion of the survey, up-to-date safety information was provided by trained medical students and a follow up survey was conducted to assess for impact of the education. Surveys were developed using standardized scoring systems from the Oxford OCEANS II study and the Kaiser Foundation COVID-19 Vaccine Monitor. Hesitancy scores before and after education delivery were tabulated to assess the impact of the quality improvement education intervention. Results: A convenience sample of 58 subjects (76% URM) cited a variety of concerns surrounding the COVID-19 vaccine. The three most common reasons for declining vaccines were potential side effects (67.3% of respondents said they were concerned to extremely concerned), the concept that COVID-19 vaccines are neither effective nor safe (64.5% said they were concerned to extremely concerned), and the risk of developing COVID-19 infection from vaccine (38.8% said they were concerned to extremely concerned). While this project remains ongoing, this information was used to address these concerns directly with patients, answer questions, clarify information, and encourage patients to get their vaccines. Through the education program, vaccine hesitancy scores improved by an average of 29% indicating an increased likelihood they will get vaccinated in the future. 38% of patients receiving education agreed to sign up for a vaccine appointment during survey interview. Conclusion: The ED often serves vulnerable patient populations. As such, its role in public health in these communities cannot be underestimated. This pilot quality improvement project is a novel method that hospital systems can use to develop and implement public health education programs to address specific community needs through the ED. These results show that ED health care providers have the ability to provide measurable change in attitudes about vaccine safety.