The Mobile Support Team (MST) was established in the Northern Sydney Local Health District (NSLHD) and has provided more than 1,734 outreach opportunistic vaccinations to people in the local community. NSLHD covers an area of 900 square kilometres with an estimated population of 985,708 residents in 2021, and maintains seven public hospitals.
The district invested resources to vaccinate priority and at-risk populations in the community from early 2021 to mid-2023 with COVID-19 and influenza vaccines. The priority and at-risk population groups included people living in high-risk accommodation settings, older people with frailty and comorbidities, and patients with cancer, renal/kidney disease and haematological conditions. Three temporary vaccination hubs were established to roll out COVID-19 vaccines, located at Mona Vale, Hornsby and Royal North Shore hospitals. The Mona Vale and Hornsby hubs closed in early 2023. The Royal North Shore hub closed on 30 June 2023, however, it re-opened on 24 July 2023 following a request from population and public health to increase flu vaccinations. The Nursing Manager for Operations established the MST in response to overcrowding in the Emergency Department (ED) and to improve patient flow. The MST provided a pathway for opportunistic and outreach vaccination to at-risk populations and for vaccination at scale.
Keeping people healthy at home
The MST operated from Monday to Friday, 14 hours a day , and on weekends, 12 hours a day. The staffing structure included the operations manager, a nursing unit manager and a pool of temporary registered and enrolled qualified authorised nurse immunisers and administrative officers. Four teams were deployed daily during the week and two on the weekends, with a 'team' consisting of one nurse and one administrative officer. The MST provided clinical care to help keep people well at home, including facilitating patient transport, blood tests, ECGs, changing simple dressings and removing sutures. It was an agile workforce that was accessible and provided continuity of care across settings. When nurses were connected with a patient, they would ask if they needed to be vaccinated and offer it. Patient eligibility for a vaccination was checked through the Australian Immunisation Register using Provider Digistal Access (PRODA) and electronic medical records. Risk assessment tools were used to determine vaccination eligibility and suitability. A preliminary assessment was conducted over the telephone, and a full risk assessment was completed face-to-face at the visit. Nurses also liaised directly with GPs and doctors through the Virtual Hospital as part of the vaccination risk assessment and consent process.
Moderna vaccinations were given any day of the week as it was available in a pre-filled syringe. Pfizer vaccination was reliant on a pharmacist to reconstitute, who were only available for this service one day a week. Four cars were available to support the outreach service, with each car was equipped to provide clinical care. The MST was utilised and promoted through the district’s Virtual hospital and the ED, along with the renal, cancer and haematology departments and hospital-in-the-home service. The service was available to large facilities such as accommodation services (residential care and disability services) and schools in the community to vaccinate teachers. A trial was undertaken for the MST to vaccinate inpatients; however, the uptake was low as patients were often too sick.
“I received a call from the Patient Flow Manager in October last year, and there were emergency department flow issues. The Mobile Support Team were established, and they decanted people out of the emergency department so that they could go home. That’s when we realised, we could do other services with these patients, such as COVID-19 and influenzas vaccinations. We have provided more than 1000 vaccinations in less than 12 months (August 2022-August 2023). We have also saved bed days in the hospital and at least $60,000 a month on transport alone. We have taken at least two patients out of the Emergency Department each day – and this has significantly improved patient flow."
Implementation enablers and barriers
Enablers
- Establishing a lead responsible for vaccination roll out, and choosing someone who really cares about people and safeguarding using vaccines.
- Increasing access to vaccines at every opportunity. Always ask patients about vaccination and offer it.
- Partnering with other services, but making sure to not ‘step on their toes’ (e.g., Hospital in the Home).
- Forecasting increased demand for services. For example, liaise with the PHN to understand when local practices are closed or are at capacity. Consider structural barriers that impact access to vaccines. Some GPs no longer provide vaccines, and people are unclear about where to get their jabs. Some local nursing homes are not taking residents to get their vaccine.
- Investing in nurses to complete approved immunisation courses and contacting large facilities directly about the option to vaccinate in their setting at scale.
- Ensuring a crosscheck PRODA and the eMR to determine eligibility – in particular, screen for recent hospitalisations, history of respiratory infection in the past six months or other factors which would impact eligibility for vaccination. If a patient is not eligible, make a note in the referral system to contact them when they become eligible.
Barriers
- Access to funding to maintain at least one vaccination hub alongside the MST. Short-term funding and uncertainty regarding whether the MST would continue after September 2023 impacted staffing retention and short-term contract extensions created an administrative burden.
- Balance efforts to promote the service with assurance the service will still be open to the community. You need to manage community expectations - and that becomes challenging when there is uncertainty about the MST being sustained after September 2023. The MST promotion could be strengthened by using the Ministry of Health portal, socials and local newspapers.
