Western Sydney Local Health District covers an area of 780 square kilometres with an estimated population of 1,144,280 residents in 2021. There are five public hospitals in the district. The district invested resources to vaccinate priority and at-risk populations between February 2021 and April 2023 with COVID-19 and influenza vaccines. Mpox (monkeypox) vaccines were available for six months.
The focus was on vaccinating people considered at high risk, including people experiencing homelessness, Aboriginal and Torres Strait Islander people, refugee populations, and people living in residential aged care facilities and group homes. Several temporary COVID-19 vaccination hubs were established at Westmead and Blacktown hospitals, Granville Community Centre, Kimberwalli and Qudos Bank Arena. The district was the first to establish a low-sensory hub for people with low-to-moderate intellectual disability, sensory disturbances, behavioural disorders or chronic mental health conditions. The district deployed mobile outreach teams centrally from the Westmead Hub and provided mobile in-reach vaccination across five facilities.
Using a mobile outreach and in-reach organisational model
At the peak of demand, eight temporary mobile outreach teams operated centrally from the Westmead Hub, with the staffing configuration for each 'team' including a doctor, nurse and administration officer. Pop-up 'mini' vaccination hubs were used to increase vaccination rates, held in community settings such as churches, mosques and community centres, and community events (e.g., NRL All-Star match). Four teams operated daily during business hours (Monday - Friday) and as required after hours.
The district established two separate in-reach teams, including one doctor for the district and a nurse at each site. Multiple channels were used to identify patients eligible for vaccination when admitted to the hospital. Lists were generated from the Patient Flow Portal, and immunisation history or vaccination status was determined through electronic medical records. Lists were generated for inpatient and outpatient settings, where the Data Quality Manager would identify eligibility for the vaccination and liaise with the nominated treating doctor (physician or medical specialist) to ensure suitability. The doctor was responsible for discussing vaccine options, benefits and harms with the patient. The Data Quality Manager would also ‘roam’ the hospital – ward to ward and clinic to clinic to identify patients eligible for vaccination and attend the emergency departments.
“It's about making health care better for these diverse communities. You just need to go out and do it in a slightly different way. Invest in a targeted approach for ongoing out-reach vaccination – pockets of community that cannot access vaccination in other ways."
Implementation enablers and barriers
Enablers
- Partnering with community leaders was vital in delivering effective outreach services.
- Connecting with people in their community for vaccination has side benefits. You can provide basic health assistance and engage in health promotion activities. Building trust with the health system in another benefit.
- Educating doctors that it’s possible to vaccinate patients in the hospital and exploring suitable touchpoints in the patients' journey (e.g. when discharging from hospital).
- Obtaining vaccination status as part of the admission process and a preliminary assessment, and simply asking patients if they were due for a COVID-19 vaccination, booster and influenza jab. When people were flagged as needing a vaccination – the in-reach team was called directly to follow up and vaccinate.
- Using multiple channels to promote in-reach vaccination to staff (e.g., promotional posters, emails, broadcasts through the paging system).
Barriers
- Identifying patient eligibility and suitability for in-reach vaccination was laborious and unsustainable — high effort for low uptake. Consider vaccination in outpatient clinics.
- Varying perceptions on the importance of vaccination from some doctors. At times, doctors decline, and you need to walk away. In most cases, patients are too sick
- Accessing the eMR can become difficult if wifi connectivity is low. You need access to the eMR to create inpatient and outpatient virtual clinics.
- Consider staff safety when coordinating a pop-up vacciniation hub.
- Consider and assess the likely risks if you vaccinate people in community settings (e.g., alcohol before or after a football match may increase risks).
