Splenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic

Am J Med. 2017 Jul;130(7):856-861. doi: 10.1016/j.amjmed.2017.01.024. Epub 2017 Feb 14.

Abstract

Background: Asplenic patients are at risk for severe infections, but adherence to recommended preventive education and vaccination is poor. The goal of this study was to demonstrate that a targeted intervention can improve vaccination rates in a population of asplenic veterans.

Methods: Surgically asplenic patients actively receiving care in our health care system were identified via a database search. Patients were contacted via mailed letters and encouraged to attend an existing travel clinic with a new process designed for asplenic patients. In the clinic, patients were educated on the risks of asplenia and proper preventive precautions, a vaccination history was taken, and patients were administered any additional indicated vaccines.

Results: The database search yielded 113 patients; an additional 14 asplenic patients were identified and referred to the clinic by providers, and 2 were referred prior to planned splenectomy. Among all asplenic patients, the first-year referral rate to clinic was 38/129 (29%). During the first year of the intervention, there were increases in the rates of 3 of 4 recommended vaccinations: pneumococcal conjugate, 19% to 55% (P <.001); Haemophilus influenzae type B, 19% to 35% (P = .007); and meningococcal vaccine, 24% to 43% (P = .002). The pneumococcal polysaccharide vaccination rate increased from 91% to 93% (P = .62).

Conclusions: Targeted interventions can improve guideline-based care for asplenic patients. The creation of a clinic designed for asplenic patients led to increases in 3 of 4 recommended vaccinations. This strategy may be applicable to other health care systems with similar numbers of asplenic patients.

Keywords: Asplenic; Preventive medicine; Quality improvement; Splenectomy; Vaccines.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care Facilities / standards*
  • Humans
  • Infection Control
  • Infections / etiology
  • Middle Aged
  • Patient Compliance*
  • Patient Education as Topic*
  • Quality Improvement*
  • Splenectomy* / adverse effects
  • Vaccination* / statistics & numerical data
  • Veterans*