Annals for Hospitalists Inpatient Notes - Another Way That Hospitalists Can Fight COVID-19
Authors: Robert Chang
Journal: Annals of Internal Medicine (2022)

Web ExclusivesFebruary 2022Annals for Hospitalists Inpatient Notes - Another Way That Hospitalists Can Fight COVID-19FREERobert Chang, MDRobert Chang, MDUniversity of Michigan, Ann Arbor, Michigan (R.C.).Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4832 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Population immunity is the surest way to control the ongoing COVID-19 pandemic and save lives. Unfortunately, most areas of the United States have not succeeded in achieving vaccination levels sufficient to control the disease, despite widespread availability of effective vaccines. Both vaccine hesitancy and missed vaccination opportunities are contributing to low levels of vaccination. The lamentable and predictable result is that many hospitals are now overrun with patients presenting with a largely preventable disease.Although vaccination has been generally regarded as an outpatient issue, there are ways that hospitalists and hospital leaders can contribute to this critically important vaccination effort.Vaccine hesitancy typically results from a lack of trust in the efficacy and/or safety of the vaccine. This lack of trust can be rooted in a lack of understanding of the facts about the vaccine or a lack of trust in the institutions that are recommending it. Fortunately, it is possible to directly counter vaccine hesitancy by offering accurate information and a strong recommendation from a trusted source (that is, a hospitalist) (1).Outside of vaccine hesitancy, even relatively informed patients may face barriers to vaccination, including the inconvenience of the process or general complacency. Therefore, it can be argued that every contact with the health system should be seen as an opportunity to facilitate vaccination. One of these opportunities may be found in hospitalization.Inpatient smoking cessation programs provide an analogous framework to consider inpatient COVID-19 vaccination (2). With smoking cessation, hospitalization serves as a “moment of opportunity,” where patients experience a profound challenge to the self-perception of their health and a potential openness to new health-related ideas. Hospitalists often assume the role of “trusted guide” through hospitalization and frequently counsel patients toward making healthy life choices, like smoking cessation. Indeed, hospitalists are perfectly prepared and positioned to have short yet profound conversations about vaccination and vaccine hesitancy.Many hospitals have smoking cessation programs that actively identify smokers and intervene to help them quit. These programs go beyond individual hospitalists, creating robust systems to improve the health of inpatients. Similarly, hospital leaders can create systems to identify unvaccinated patients and facilitate vaccination during hospitalization. Many hospitals already use similar systems for influenza vaccination, using hospitalization as a moment of opportunity to vaccinate patients who may otherwise be missed.At our hospital, we have created an inpatient COVID-19 vaccination program designed to vaccinate as many eligible patients as possible. The admitting nurse screens each patient to clarify their vaccination status. Unvaccinated patients (without contraindications) are asked if they would like to receive the vaccine. If a patient desires the vaccine, the provider is alerted (via the electronic health record) to approve the order, and the vaccination is given in the hospital. If the patient declines the vaccine, the inpatient provider can be notified, allowing them to counsel the patient. In this way, interested patients are vaccinated expeditiously, and hesitant patients are identified for targeted education and a strong recommendation.Hospitalists can contribute to the COVID-19 vaccination effort by doing the following:1. Remain educated and be able to address common questions about vaccination. The Centers for Disease Control and Prevention recommendations for COVID-19 vaccination continue to evolve. The latest updates can be found at www.cdc.gov/coronavirus/2019-ncov/whats-new-all.html. Hospitalists should know some key facts. First, although the current messenger RNA vaccines are less effective in preventing infections from the Delta variant, they remain highly effective at preventing severe outcomes (that is, hospitalization and death) (3). Second, moderately or severely immunocompromised persons aged 12 years or older (Pfizer–BioNTech recipients) or 18 years or older (Moderna recipients) should receive an additional primary dose of the same vaccine 28 days or more after completion of the initial 2-dose series. Third, booster shots are recommended for all patients aged 18 years or older. The booster should be given at least 6 months after completing 1 of the messenger RNA primary vaccine series and at least 2 months after the Janssen vaccine. The booster does not need to be of the same type as the primary vaccine. Finally, for hospitalized patients in the United States, immunity due to vaccination is superior to immunity due to primary COVID-19 infection, with less comorbidity, even for the Delta variant (4). Patients who have been infected with SARS-CoV-2 should still receive COVID-19 vaccination.2. Use evidence-based strategies when counseling patients about COVID-19 vaccination (5). First, provide novel information that may be motivating. For example, “We are now learning that COVID-19 infections can result in longer-lasting and debilitating health problems, such as fatigue, headaches, joint pain, and sleep problems.” Second, frame the message in terms of gains and appeal to altruism and prosocial behavior. For example, “Getting the COVID-19 vaccine will protect you from infection and will also protect the people you care about.” Third, confront inaccurate information directly. For example, “That is a common misconception that has, unfortunately, been sensationalized in the popular media.” Finally, make strong recommendations. For example, “COVID-19 vaccination is extremely safe and highly effective, and I strongly recommend that you get the vaccine today.”3. Engage your health system to create an inpatient COVID-19 vaccination program, as described earlier.As we approach the 2-year anniversary of the COVID-19 pandemic, vaccination has clearly become our best way out of the COVID-19 nightmare. Hospitalists have risen to the challenge of caring for the multitudes of patients hospitalized with COVID-19. Now, we have an opportunity to fight COVID-19 in a different way, by promoting vaccination for all of our hospitalized patients.References1. Motadel D. Vaccine hesitancy is as old as vaccines. I take comfort in that. The New York Times. 28 April 2021. Accessed at www.nytimes.com/2021/04/28/opinion/vaccine-hesitancy-smallpox.html on 28 September 2021. Google Scholar2. Rigotti NA, Clair C, Munafò MR, et al. Interventions for smoking cessation in hospitalised patients. Cochrane Database Syst Rev. 2012:CD001837. [PMID: 22592676] doi:10.1002/14651858.CD001837.pub3 CrossrefMedlineGoogle Scholar3. Scobie HM, Johnson AG, Suthar AB, et al. Monitoring incidence of COVID-19 cases, hospitalizations, and deaths, by vaccination status - 13 U.S. jurisdictions, April 4-July 17, 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1284-1290. [PMID: 34529637] doi:10.15585/mmwr.mm7037e1 CrossrefMedlineGoogle Scholar4. Bozio CH, Grannis SJ, Naleway AL, et al. Laboratory-confirmed COVID-19 among adults hospitalized with COVID-19-like illness with infection-induced or mRNA vaccine-induced SARS-CoV-2 immunity - nine states, January-September 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1539-1544. [PMID: 34735425] doi:10.15585/mmwr.mm7044e1 CrossrefMedlineGoogle Scholar5. Finney Rutten LJ, Zhu X, Leppin AL, et al.. Evidence-based strategies for clinical organizations to address COVID-19 vaccine hesitancy. Mayo Clin Proc. 2021;96:699-707. [PMID: 33673921] doi:10.1016/j.mayocp.2020.12.024 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Robert Chang, MDAffiliations: University of Michigan, Ann Arbor, Michigan (R.C.).Disclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4832.Corresponding Author: Robert Chang, MD, University of Michigan, F-4313 UH-South, Level 4, 1500 East Medical Center Drive, Ann Arbor, MI 48109; e-mail, [email protected].umich.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - February 2022 Megan Mack , Matthew Luzum and David H. Wesorick Metrics February 2022Volume 175, Issue 2Page: HO2-HO3KeywordsCOVID-19HospitalistsHospitalizationsVaccine hesitancyVaccines ePublished: 15 February 2022 Issue Published: February 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...