• pneumococcus;
  • immunization;
  • emergency medicine;
  • health services accessibility;
  • primary prevention;
  • urban population


  1. Top of page
  2. Abstract
  3. References

Abstract. Objective: To test the feasibility of pneumococcal immunization in an ED. Methods: Cook County Hospital has an annual ED census of 120,000. Patients are 75% black and 15% Hispanic. Eighty-two percent of patients are uninsured. Seventy-three percent report no primary physician. Between May 27, 1997, and July 26, 1997, nurses had standing orders that patients meeting CDC-recommended criteria were to be offered pneumococcal immunization. Immunization was recorded in the system-wide registration computer. Results: During the study period, 1,833 patient screenings encounters (13% of all patients) identified 1,493 high-risk patients. Only 10% of screened high-risk patients reported previous pneumococcal immunization. 1,173 were immunized against pneumococcus. Median number of immunizations per nurse per shift was 1.62. Patient throughput was not altered. Conclusion: Pneumococcal immunization is both necessary and feasible in a busy ED serving patients with little access to other immunization services.


  1. Top of page
  2. Abstract
  3. References
  • 1
    Centers for Disease Control and Prevention. Prevention of pneumococcal disease. MMWR. 1997; 46: RR-9.
  • 2
    Butler JC, Breiman RF, Lipman HB, et al. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA. 1993; 270: 182631.
  • 3
    Sisk JE, Moskowitz AJ, Whang W, et al. Cost effectiveness of vaccination against pneumococcal bacteremia among elderly people. JAMA. 1997; 278: 13339.
  • 4
    Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination coverage levels among adults aged >65.years—United States, 1995. MMWR. 1997; 46: 9139.
  • 5
    Centers for Disease Control and Prevention, National Center for Health Statistics. Healthy People 2000 Review 1997. Hyattsville, MD, 1997.
  • 6
    Centers for Disease Control and Prevention. Race-specific differences in influenza vaccination levels among Medicare beneficiaries—United States 1993. MMWR. 1995; 44: 24733.
  • 7
    General Accounting Office. Immunization: HHS could do more to increase vaccination among older adults. 1995; GAO/PEMD-95-14.
  • 8
    Rask KJ, Williams MV, Parker RM, et al. Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. JAMA. 1994; 271: 19313.
  • 9
    Baker DW, Stevens CD, Brook RH. Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. JAMA. 1994; 271: 190912.
  • 10
    Kellermann AL. Nonurgent emergency department visits: meeting an unmet need. JAMA. 1994; 271: 19534.
  • 11
    Schappert SM. Ambulatory care visits to physician offices hospital outpatient departments, and emergency departments: United States, 1995. National Center for Health Statistics. Vital Health Stat. 1997; 13(129).
  • 12
    Slobodkin D, Zielske P, Kitlas JL, et al. A demonstration of the feasibility of systematic immunization against influenza and pneumococcus in an inner city emergency department. Ann Emerg Med. 1998; 32: 53743.
  • 13
    Rodriguez RM, Baraff LJ. Emergency department immunization of the elderly with pneumococcal and influenza vaccines. Ann Emerg Med. 1993; 22: 172932.
  • 14
    Wrenn K, Zeldin M, Miller O. Influenza and pneumococcal vaccination in the emergency department: is it possible J Gen Intern Med. 1994; 9: 4259.
  • 15
    Polis MA, Davey VJ, Collins ED, et al. The emergency department as part of a successful strategy for increasing adult immunization. Ann Emerg Med. 1987; 17: 10168.
  • 16
    Williams RM. The costs of visits to emergency departments. N Engl J Med. 1996; 334: 6426.