• Tomona Iso, Fangzheng Yuan, Elsie Rizk, TranAnh ThuATDepartment of Pharmacy, Houston Methodist, Houston, TX, USA; Department of Surgery, Houston Methodist, Houston, TX, USA., R Benjamin Saldana, Prasanth R Boyareddigari, Ngoc-Anh A Nguyen, Daniela Espino, Julia S Benoit, and Joshua T Swan.
• Department of Pharmacy, Houston Methodist, Houston, TX, USA; Department of Surgery, Houston Methodist, Houston, TX, USA.
• Am J Emerg Med. 2022 Apr 1; 54: 242-248.

BackgroundAdministering subsequent doses of rabies vaccine is not a medical emergency and does not require access to emergency department (ED) services. This study reviewed ED visits for rabies postexposure prophylaxis (PEP) to identify avoidable ED visits for subsequent rabies vaccination.MethodsThis retrospective study included patients who received human rabies immune globulin (HRIG) or rabies vaccine at 15 EDs of a multi-hospital health system from 2016 to 2018. All ED visits were classified as initial or non-initial healthcare visits after animal exposure. Emergency department visits for non-initial healthcare were classified as necessary (HRIG administration, worsening symptoms, other emergent conditions, or vaccination during a natural disaster) or avoidable (rabies vaccination only).ResultsThis study included 145 patients with 203 ED visits (113 initial and 90 non-initial healthcare visits). Avoidable ED visits were identified for 19% (28 of 145) of patients and 66% (59 of 90) of ED visits for non-initial healthcare. Contributing factors for avoidable ED visits were suboptimal ED discharge instructions to return to the ED for vaccination (n = 20 visits) and patients' inability to coordinate outpatient follow-up (n = 17 visits). Patients with previous avoidable ED visits had a 73% probability for unnecessarily returning to the ED for vaccination. The average number of avoidable ED visits observed per patient was 0.41 (95% CI = 0.25 to 0.56). Since the Centers for Disease Control and Prevention reports that 30,000 to 60,000 Americans initiates rabies PEP each year, we estimate that 7500 to 33,600 avoidable ED visits occur for rabies vaccination in the US each year.ConclusionsOne of 5 patients who received rabies PEP in the ED had avoidable ED visits for subsequent rabies vaccination. This study highlights systemic lack of coordination following ED discharge and barriers to accessing rabies vaccine.Copyright © 2022 Elsevier Inc. All rights reserved.

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