The impact of a walk-in clinic referral protocol on rabies vaccination emergency department visits.

BACKGROUND

Rabies is fatal without proper management, though rabies is well controlled in the United States, it poses significant strain on emergency departments (ED). Proper rabies care accumulates high costs and multiple clinical encounters. Due to low patient numbers and high medication costs, many outpatient settings don't provide rabies vaccinations, causing patients to return to the ED and endure unnecessary costs. Prior studies have described referral processes for subsequent vaccines but observed limitations. At our institution, a referral protocol was implemented for a walk-in clinic 0.6 miles from the ED, open daily.

METHODS

A retrospective pre- and post-protocol single center study was conducted to evaluate the results of this process improvement protocol. The intervention was the implementation of a referral protocol for subsequent vaccinations. Adults treated in the Adult ED at the study site were included; pre-exposure prophylaxis patients were excluded. The primary outcome of this analysis was the number of return ED visits for subsequent rabies vaccinations following the initial presentation.

RESULTS

231 patients were included in the data analyses. The average number of ED visits was 1.722 in the pre-cohort and 1.238 in the post-cohort (p = 0.00042). 63.3 % of patients received the complete rabies vaccination series within the pre-cohort and 69.7 % in the post-cohort.

CONCLUSIONS

Walk-in clinic referral protocol implementation in an adult ED reduced the number of ED visits per exposure and increased the incidence of vaccination regimen completion. Implementation of a referral protocol presents as a favorable strategy in offloading unnecessary ED census in overwhelmed healthcare systems.