Background Influenza outbreaks are a major public health concern yet the majority of work to improve immunisation rates has occurred within primary care settings. Children and patients with medical complexity are particularly at risk for complications due to influenza. Emphasis on immunising all patients against the flu, including patients seen in specialty clinics, is essential to help prevent the acquisition and spread of the influenza virus.

Objectives To improve flu immunisation rates for paediatric patients with chronic diseases across multiple medical divisions representing unique patient populations.

Methods Over a five year period we oversaw a multi-disciplinary, nursing-focused QI collaborative including primary care and specialty clinics at a freestanding children’s hospital. The QI collaborative included monthly meetings with divisional champions, nursing leadership, pharmacy, and marketing for data review and synergistic learning. Key improvement initiatives included the development of standardised division-specific processes, implementation of a web-based dashboard for real-time data feedback, phone calls to patients and families to encourage and document flu immunizations, and a hospital-wide marketing campaign focused on patient and provider education. Five divisions followed the same disease-specific population, tracking data monthly, over the five year period.

Results From the 2013 to the 2017 flu season, immunisation rates increased significantly (p=0.0270). Populations included patients with sickle cell disease (58% to 84%), inflammatory bowel disease (35% to 65%), cystic fibrosis (79% to 89%), diabetes (20% to 70%), and patients on dialysis (89% to 100%).

Conclusions The creation of a multidisciplinary, nursing-focused collaborative was associated with significant improvements in influenza immunisation rates in specialty populations.