At the University of Kansas Health System, Assistant Chief Nursing Officer Kim Dixon said they implemented a few practices that helped. They created a wait list of patients in a specific age bracket who could come to the hospital at short notice to receive a vaccine if there was a surplus.
Once the health system opened up vaccines to patients, and then the general public, they only scheduled appointments when the county health department told them how many vaccines they’d receive.
“There’s nothing I think more frustrating for a patient than to be on the list and thinking they’re coming for the vaccine and know they have it scheduled, and then find out they’re out,” Dixon said, adding that they schedule vaccines by six or 10 people at a time, depending on whether they have Pfizer or Moderna vaccines.
Dixon said they were able to plan some of these aspects early on because of their health system’s experience with ambulatory care. “The piece that adds the twists are the different variables that get entered from the counties and the state, so we do need to have some fluidity in there, and being able to move to whatever we’re being asked to move towards,” Dixon said.
That now includes having to make sure the people vaccinated are residents of Kansas and of their county, a directive recently given by the state. Likewise, Missouri has the same policy.
“But yet when you’re a patient of the health system, you might live in Missouri and be here and be 65 and older,” Dixon said. “As healthcare providers, we want to take care of our patients, and knowing we can’t administer it to just anybody is concerning.”
UKHS also used multiple community methods to get in touch with patients and community members, including phone calls, social media, emails and letters in the mail. Orlikoff said this is critical, because otherwise some can be excluded from access.
“Some people have been excluded because they’ve been healthy, and they’re not a patient of a health system so they don’t have a MyChart,” Orlikoff said. “If you’re only supposed to provide it to your patients, that’s not a problem. But if you’re supposed to provide it to the whole community, that’s a problem.”
Maryellen Guinan, a principal policy analyst at trade group America’s Essential Hospitals, said hospitals can also work outside their own walls to reach the most vulnerable through things like mobile vaccination units, working with hospital social workers to reach homebound patients, and setting up drop-in clinics for uninsured community members.
“One of our members down in San Antonio was able to convert space in the first floor of a mall, and worked with the fire department and the police department to make sure that essential workers were coming in,” Guinan said. “All of the hospitals that were there in the beginning still have the capacity to vaccinate their patient populations and those in the community, and we want to make sure they have the supply to do so.”
As Guinan noted, in many parts of the country, hospitals are now not in the driver’s seat of vaccine distribution. Instead, local health departments are diversifying vaccine locations. Arthur Caplan, a medical ethicist at the NYU School of Medicine, said the shift is an opportunity for hospitals to send their workers to the various sites, or to partner with a county to host a vaccine clinic.
“There are a lot of people who know how to administer vaccines that work in hospitals, and I think we want to share that workforce more now,” Caplan said.
Meanwhile, some of the most eye-catching and ethically egregious stories to come from the first three months of health system distribution were stories of hospitals offering vaccines to donors and others with ties to the hospital before the general population, or outside of a specified age range. Organizations like Overlake Medical Center in suburban Seattle offered vaccines to donors during the 1A rollout. Overlake didn’t respond to inquiries from Modern Healthcare for comment.
The American Hospital Association in a statement to Modern Healthcare said that hospitals don’t want to waste vaccines, and may choose to administer extra doses to staff or others who are “members of the hospital community.”
The trade association also added that every hospital and locality is unique and therefore a national, “single playbook would not suffice.” AHA did, however, say that it is useful to share best practices.
Parker at UChicago Medicine said they avoided those issues by focusing on those who needed the vaccine the most.
“There were definitely big, powerful donors who were annoyed that they had to wait a little bit,” Parker said. “But you know, I think our approach was much more equitable and resulted in the majority of our vaccines going to Black and Latinx people, which is what you would expect. That’s who we serve. The thing about equity is it isn’t hard. You just have to be intentional about it.”