Clinical research studySplenectomy as a Destination: Improving Quality of Care Among Asplenic Veterans Through a Travel Clinic
Section snippets
Methods
To identify asplenic patients at our facility, we queried the Corporate Data Warehouse, a centralized database for all patients cared for within the US Department of Veterans Affairs (VA) health care system. We identified patients 1) who had undergone a surgery containing “splenectomy” in the procedure name from January 1, 2000 through November 2, 2014 (the project start date), or 2) had the word “splenectomy” in their electronic problem list. Patients known to be deceased were excluded in this
Preintervention Data
We identified 168 patients, of whom 21 had undergone splenectomy at the Durham VA Medical Center, and 147 patients had prior splenectomy documented in their problem list. After removal of duplicate records (n = 6), patients found to be deceased on manual chart review (n = 4), and patients no longer cared for at the Durham VA (n = 45), 113 patients remained. These patients received an invitation to attend the clinic and an information pamphlet about asplenia (supplementary materials, available
Discussion
Our study demonstrates that this novel approach to improving the guideline-based care of asplenic patients was successful in increasing the rates of appropriate vaccination. Our approach built on the existing infrastructure of a travel clinic in order to meet the needs of this population without expenditure on additional personnel, training, or clinic space. The strategy was multidisciplinary by necessity, and involved collaboration among nurse practitioners, infectious diseases clinicians,
Acknowledgment
We wish to acknowledge the contributions of the following individuals, each of whom has given written permission to be included in this manuscript: Brian P. Hayes, MD, Department of Medicine, Durham Veterans Affairs Medical Center: Contributed to implementation of the intervention and reviewed manuscript; Rebekah Moehring, MD, Departments of Medicine, Duke University School of Medicine and Durham Veterans Affairs Medical Center: Contributed to implementation of the intervention and reviewed
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Cited by (8)
Meningococcal vaccination in patients with newly diagnosed asplenia in the United States
2021, VaccineCitation Excerpt :Additionally, this survey finding also indicates that pediatricians may be more aware of the MenB high-risk recommendations compared to family physicians. In an attempt to improve vaccine coverage for asplenic patients, a US study invited veterans who had undergone splenectomy (identified via a database search) to a clinic where they received education about their infection risk; their vaccination history was taken; and vaccinations were offered [21]. This improved meningococcal vaccination rates from 24% (before the intervention) to 32% (among those who were invited but did not attend) or 90% (among those who attended) [21].
The Impact of Standardized Infectious Diseases Consultation on Postsplenectomy Care and Outcomes
2022, Open Forum Infectious DiseasesPreventing infections in children and adults with asplenia
2020, Hematology (United States)
Funding: This study was unfunded.
Conflict of Interest: All authors have no conflicts of interest to disclose.
Authorship: APM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors had full access to the data, were directly involved in writing the manuscript, and have approved this final version.