key: cord-0804780-fnap8o74 authors: Simons, Sarah N; Hutton, Jennie; Walker, Katie; Harding, Sally title: Opportunistic COVID‐19 vaccination in the emergency department date: 2021-10-30 journal: Emerg Med Australas DOI: 10.1111/1742-6723.13883 sha: df3ef126eadb040bd51bd659ff7a1dab1acc5d7d doc_id: 804780 cord_uid: fnap8o74 nan 23% of emergency presentations were by people living in the most socioeconomically disadvantaged areas. 1 Structural racism and colonialism have fuelled health inequalities for Indigenous Australians, who make up 7.5% of Australian ED presentations despite only comprising 3.4% of the population. 1 The pandemic has intensified inequities within our society; the conditions experienced by people with socio-economic disadvantage predispose to a greater risk of virus acquisition and a higher incidence of physical and mental multimorbidity implicating adverse outcomes from COVID-19 infection. 2 We audited the immunisation status of the 400 patients who presented most frequently to our ED (>6 presentations to the ED per annum). Only 47% of this cohort had received a first vaccine dose compared to 69% of the Victorian population at the time of writing (Tables S1,S2). Consequently, we have implemented opportunistic COVID-19 vaccination in our ED for patients based on eligibility criteria (Table S3 ). This has resulted in up to five vaccinations daily in the context of 145 patient attendances per day. This process is illustrated in Figure 1. The use of an external vaccine supplier removes the need for the ED to manage complex cold-chain storage requirements and avoids wastage. Any Australian healthcare worker wishing to become a COVID-19 vaccine provider must complete the free online government accreditation course 3 and undertake local training to use state-based vaccine documentation systems. Vaccinators in Victoria must also administer five supervised vaccinations. The service is available to ED patients on a weekday morning; we are unable to keep patients for the sole purpose of vaccination and outside of a feasible time-frame patients are signposted to local services and supported to book an appointment. Opportunistic vaccinations in the afternoon are occasionally facilitated with surplus doses from our hospital's mobile clinic and we have plans to acquire the use of a separate discharge lounge area for vaccination. Very few eligible patients have declined vaccination which supports evidence from American EDs. 4 Instead, our patients cite numerous barriers to vaccination; 40% of Australians are functionally illiterate 5 and many describe significant competing daily priorities such as finding shelter for the night or navigating an immediate threat of family violence. Furthermore, these patients are often without smartphones or the internet access required to negotiate online appointments. Start-up resources required to implement opportunistic vaccination in the ED include lead FACEM, management, pharmacy, vaccination centre and ED clinician engagement and the provision of suitable vaccine storage units. Our ongoing resource requirements comprised a dedicated ED nurse on weekday mornings (0.5 EFT for 12 weeks) who is able to collect and then vaccinate eligible patients; 1 h of a pharmacist's time per day, continuous lead FACEM input and registrar champions are also necessary. Hospital and vaccination hub managers required regular clear communication and written protocols to meet the governance requirements of both the hospital and the hub. Vaccine equity must be prioritised to end this pandemic safely and in the words of the World Health Organization, 'no one is safe until everyone is safe'. We cannot solely offer vaccination where we want or hope people will bewe must also provide safe and opportunistic immunisations where we know vulnerable people are, including in our EDs. University, Melbourne, Victoria, Australia doi: 10.1111/1742-6723.13883 Additional supporting information may be found in the online version of this article at the publisher's web site: Table S1 . Vaccination status of frequent ED attenders (>6 visits per annum) according to housing status on September 15th 2021. Table S2 . Vaccination status of highfrequency ED attenders compared to the general Victoria (Australia) population on September 15th 2021. Table S3 . Eligibility criteria for opportunistic vaccination in the ED. Australian Institute of Health and Welfare. Impact of COVID-19 on Emergency Department activity. MyHospitals Factors associated with COVID-19-related death using OpenSAFELY Covid-19 Vaccination Training: Australian Government Department of Health The rapid evaluation of COVID-19 vaccination in emergency departments for underserved patients study Organisation for Economic Cooperation and Development. AUS-TRALIA -Country Note -Survey of Adult Skills First Results. Organisation for Economic Co-operation and Development The authors acknowledge Susan White and Royal Exhibition Building Vaccination Centre staff, Melbourne. KW is a section editor for Emergency Medicine Australasia.