HUP Case Study

NEW: PowerPoint presentation by Amy Behrman, MD at Hershey training session 26 July 2011: HUP Case_Behrman PPT_19 Jul 2011


Case Study Snapshot
HUP (Hospital of the University of Pennsylvania

After robust seasonal vaccine campaigns for its HCWs over several years, HUP decided to adopt a mandated program after extensive consultation across medical, nursing and administrative leadership.  

Seasonal Influenza Vaccine Uptake

            Pre-mandate                                                      Post-Mandate

  ≈ 54%*                                                     99.3%

2008-09 (60% of clinical staff)                        plus 0.6% exemptions for HUP

Program Justification
Positioned as a patient safety/staff safety initiative

Program Details
– establishes annual seasonal flu vaccination as a condition of employment
– includes all employees, volunteers, students, vendors
– includes faculty, physicians and clinical staff from UPenn
– integrates exemptions based on standard form: medical – reviewed by the OC Director with backup from Infection Control Director; religious – reviewed by HR officer: 1-2% incidence rate

Key Champion(s)
PJ Brennan, CMO
Infection Control and Occupation Health

– Influenza vaccination as a quality focus begins

Spring  2009:
– HUP IM/EM physician survey spring 2009 supported a mandatory vaccine policy (DeSante et al 2010)
– Review of program outcomes for 2008-2009
. 4th consecutive year of increased vaccination rates but only modest gains with great efforts at outreach
.  Infection Control and Occupational Medicine consensus on need for requiring vaccination
. Nursing leadership support for mandate
. Physician leadership support for mandate
. HR leadership support for mandate
. OGC (Office of General Counsel/Law) support for mandate

Fall 2009/Winter 2010:
– Required influenza vaccination for all HCWs supported by
–        Educational programs, website
–        Interactive live and electronic Q&A
–        Exemption reviews, medical and religious
–        Continued multi-faceted outreach to all staff @ all locations

Fall 2010/Winter 2011
– Second cycle with stable performance at 99%+ uptake with stable exemptions

Key Strategies/Success Factors
– Define target population early, announce clearly
– Assure robust tracking system, and ability internal reports for local manager action/follow-up
– Have plan for interrupted vaccine supply/triage plan
– Develop detailed exemption review process
– Develop policies around verifying outside vaccination/documentation levels
– “Stickers” verifying vaccination status a matter of pride (red dot/blue dot)

Best sound bite(s)
PJ Brennan, CMO, went around table at Medical Board meeting:
Q: Will you withdraw privileges to docs who are non-compliant with the influenza vaccination mandate?
A. Unanimous “yes”

Leadership Team (functions that made it happen)
Occupational Medicine
Infection Control
HR, Law
Nursing Administration

Hospital of the University of Pennsylvania (HUP)
The Hospital of the University of Pennsylvania (HUP) is world-renowned for its clinical and research excellence, forging the way for newer and better ways to diagnose and treat illnesses and disorders. Its long and rich history of top-notch patient care began more than two centuries ago with the founding of the nation’s first medical school, the University of Pennsylvania. Since 1765 when it first opened its doors, Penn has been dedicated to the training of physicians and the discovery and implementation of new medical knowledge.

The world-class faculty and staff of the Hospital of the University of Pennsylvania are dedicated to superior patient care, education and research for a better, healthier future. Their significant and groundbreaking contributions to medicine are recognized both nationally and internationally. The interdisciplinary team of professionals provides personalized care and service to patients — all within a  compassionate and respectful environment. Innovative research coupled with responsive, hands-on care allows Penn to tailor treatment specifically to individual patient needs.

HUP’s reputation as a world leader in medical research and clinical care attracts the highest quality medical specialists from around the world. The supportive and collaborative environment encourages physicians and staff to keep reaching ahead to find new ways to improve the quality and length of life for everyone.

Amy Behrman, MD
Director, Occupational Medicine
427 Penn Tower
Hospital of the University of Pennsylvania
Philadelphia, PA   19104

 Additional Perspectives

Program Overview: 2004-2009
–        Free vaccine available to all HCWs T/O Flu season
–        Vaccination on-site in all inpatient units, clinics and non-clinical sites, offered all shifts
–        Vaccine given to employees at cafeteria
–        Vaccine in public hospital areas via  “Flu fairs” with educational materials, games, and incentives
–        Vaccine available on a walk-in basis in the OM clinic 8-12 hours/day.
–        Needle-free FluMist provided for medically eligible staff who preferred it.
–        Declination forms analyzed to define HCW concerns
–        Influenza vaccine education via hospital newsletter, email, intranet, KL, and managers’ meetings.
–        Flu shot music video using hospital staff to address concerns about vaccine safety and efficacy based on previous declination forms:

HUP IM/EM Physician survey spring 2009 supported a mandatory vaccine policy (DeSante et al 2010)
–        90% believed HCWs have an obligation to their patients to be vaccinated
–        85% believed HCW vaccination should be mandatory
–        Those with more patient contact were more likely to be vaccinated, more likely to support mandates, and more likely to vaccinate their patients

HUP use of stickers for name badges, initiated to confirm TB vaccination, extended to seasonal and H1N1 vaccination in 2009-2010 (green sticker for 2010-2011):


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