Increasing Flu Vaccination Rates at Children's Hospital Colorado

Collaborative Team-Based Approach Yields Significant Progress

​​Suchitra Rao, MD, Works to Increase Flu Vaccination Rates at Children’s Hospital Colorado 

It’s that time of year again: December to March is flu season and at Children’s Hospital Colorado, Suchitra Rao, MD, is hard at work.

Dr. Rao​ is an infectious disease physician who has spent several years studying the epidemiology of flu. She is also the director of two multidisciplinary teams: the Influenza Task Force and the Influenza Vaccine Advisory Committee, which are responsible for immunizing staff, patients and patients’ families. 

“Over the past four years we admitted approximately 400 patients for flu,” said Dr. Rao. “The complications, such as respiratory failure, encephalitis, myocarditis and multi-organ failure, can be very serious.” 

The CDC recommends an annual vaccination for everyone aged six months and older, but national rates remain much lower than the target goals. At Children’s Colorado, Dr. Rao has opted to tackle this problem by optimizing the electronic health record (EHR). 

“We discovered that fewer than 50 percent of our inpatients had been vaccinated against influenza, and up to 40 percent of those admitted for flu had an opportunity to be vaccinated at a prior visit,” Dr. Rao said. 

“The most effective solution turned out to be a series of provider reminders, using features in the EHR. We developed a best practice advisory and a dashboard showing an overview of vaccine rates. We also instituted nursing standing orders linked to the best practice advisory, to empower nurses to provide the best care.” 

This approach has achieved significant results: patient vaccination rates are up by approximately 30 percent among patients whose providers received the additional reminders. 

Dan Hyman, MD,​ chief quality and patient safety officer, says that Dr. Rao’s efforts to increase influenza vaccination rates have been significant. 

“Dr. Rao has developed the types of innovative approaches to improvement that will define many of our efforts in the coming years,” he said. “Clinicians will be supported by EHR-based tools that will help us provide better care for our patients, and Dr. Rao is leading the way in this regard.” 

Despite this high praise, Dr. Rao remains humble. “There have been so many people involved in these projects,” she said. “Our IT colleagues in particular have been phenomenal in responding to our requests and coming up with innovative solutions. It really is a collaborative, team-based approach, and we would not have been able to achieve these successes without everyone’s hard work.” 

But given the current climate of anti-vaccination propaganda, has Dr. Rao encountered any obstacles along the way? 

“We do have some families who enter the hospital with very defined ideas about vaccinations, so we spend quite a bit of time explaining that vaccinations are safe and the most effective protection against flu. For many of our vulnerable populations they may help to save the child’s life.” 

Yet flu can strike anyone, not just those with existing health issues or compromised immune systems. Dr. Rao’s experience with one patient will stay with her for a long time. 

“Several years ago we admitted an eight-year-old boy who was in perfect health until he developed influenza,” she said. “He ended up in the hospital for five months with respiratory failure, myocarditis, bacterial pneumonia and renal failure, and had to be put on ECMO – cardiopulmonary support – for three months.” 

“When you work with patients for such a long period of time you can form a strong bond. It was wonderful to see him getting stronger each day. It always brings a smile to my face to think about how far he came, but it is painful to know that it all may have been avoided with a simple vaccination.” 

Looking toward the future, Dr. Rao plans to study how vaccination can prevent flu-related hospitalization, and how we can make predictions about future flu seasons. 

“Working in this environment means we are in the best position to fight flu and its complications,” she said. “Our most vulnerable populations are right here in front of us, and we can really make a difference with a targeted and sustained approach.” ​