Rolling With COVID-19 Vaccinations

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An Emergency Department’s experience providing COVID-19 shots. 

By March 2021, the State of Delaware was desperate to get more patients vaccinated.  Our healthcare workers and high-risk patients were vaccinated and our vaccine clinic was beginning to look for patients around the hospital who could use the leftover doses from the clinic.  ED physicians were asking patients if they were vaccinated and unvaccinated patients started to ask if they could get vaccinated while in the ED. This led to a discussion with administration and the pharmacy department about how to roll out an ED based COVID-19 vaccination program.


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Since April of this year, The Saint Francis Hospital ED has been able to offer patients vaccination.  Saint Francis has both Moderna and J&J and interested patients are given the choice.  Once the first vial is broken open, the hospital has 12 hours to find as many takers as possible.  If a visitor or family member is with a patient and they also want it, we can provide it to them without needing to register them as an ED patient. Vaccination is also offered to some unvaccinated patients being discharged from the inpatient units.

The workflow for giving the vaccination is straightforward — the physician/PA puts in the order and about 20 minutes later the vial is delivered to the ED by pharmacy. For Moderna recipients, there is some paperwork advising them of how to go about getting their second dose.  This is not a time-consuming process.  Typically, the process begins prior to the patient being ready for discharge, in which case it will not extend the patient’s length of stay.

Emergency Medicine has always been a safety net and has always played important roles in public health.  We provided tetanus shots without a thought for any patient with a break in their skin, rabies vaccines, prescribe blood pressure prescriptions for patients with untreated hypertension, routinely test and treat for STDs and STD exposures etc. So why wouldn’t we provide what is by far the most meaningful intervention for COVID-19?


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The ability to administer vaccination changes the physician-patient dynamic.  Knowing that we can provide vaccination makes it much more likely that we both asks about vaccination status and enter into a discussion about it.

In doing so, we have gained insight as to most of the reasons why patients have not yet been vaccinated.

The most common is anxiety and fear over the vaccine (often stemming from the patient being very misinformed).  Most of these patients have never had a conversation with a health care provider about vaccination and many hesitant and fearful patients quickly become receptive.  Others just have not gotten around to it – this seems very strange to most of us, but some patients truly just need to be in the right place at the right time.  For these patients, getting vaccinated since they are in the ED anyway makes sense.

Since we started offering this service in April, we have vaccinated several hundred patients in the Emergency Department.  It takes minimal extra time to do this and provides what may be a life-saving service to the patient and has a positive impact on the community.


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Earlier in the summer, it was not unusual for up to 10% of discharged patients going home having received a vaccination.  These numbers have recently waned as many of the “hesitant” have been vaccinated, leaving the more adamant “anti-vaxxers” for whom discussion is usually futile.

In November, we switched from Moderna and J&J to Pfizer, and we are now able to give booster doses to previously vaccinated patients.  While the number of patients open to receiving their first vaccination has dwindled, this had been countered with an increasing number of patients enthusiastic to receive their booster.

Our role in the public health sphere may never have been greater and not providing the opportunity to vaccinate patients represents a lost opportunity to educate and serve a patient and surrounding communities.  I encourage other emergency department teams to see if they can provide COVID vaccinations to their patients.

ABOUT THE AUTHOR

Dr. Nisbet is Chairman of the Emergency Department and EMS Medical Director at Saint Francis Hospital in Wilmington, Delaware.

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