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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Mitchell, AP; Boggan, JC; Lau, K; Simel, DL

Published Date

  • July 2017

Published In

Volume / Issue

  • 130 / 7

Start / End Page

  • 856 - 861

PubMed ID

  • 28213046

Electronic International Standard Serial Number (EISSN)

  • 1555-7162

Digital Object Identifier (DOI)

  • 10.1016/j.amjmed.2017.01.024


  • eng

Conference Location

  • United States