OBJECTIVES : The Centers for Disease Control and Prevention estimates that 30,000 to 60,000 patients receive rabies postexposure prophylaxis (PEP) annually in the United States. Following animal exposure, patients may seek initial healthcare in an emergency department (ED) for wound cleaning, rabies immune globulin (IG), and the initial dose of rabies vaccine series of 3-5 doses. Subsequent doses of rabies vaccine can be administered in the community (primary care, community pharmacies, and infectious disease clinics) and do not require emergency services. This study estimated the prevalence of unnecessary ED encounters for rabies vaccination.

METHODS : This study included a 10% random sample of 361 rabies PEP ED encounters observed across 15 EDs at a large urban health system from January 2015 to June 2018. Each ED encounter was characterized as index (first healthcare received following animal exposure) or non-index. Non-index encounters were further classified as necessary (rabies IG or other emergent conditions) or unnecessary (rabies vaccination only).

RESULTS : The study included 36 ED encounters (23 index and 13 non-index) from 33 patients. Two non-index encounters were necessary for management of a bone fracture (n=1) or rabies IG administration (n=1). The prevalence of unnecessary ED encounter was 31% (11 of 36; 95% confidence interval: 16% to 48%). The reasons for unnecessary ED encounters for rabies vaccination were previous ED discharge instructions to return to the ED (n=6), lack of follow-up instructions at previous ED discharge (n=4), and unclear documentation (n=1).

CONCLUSIONS : Approximately 16% to 48% of ED encounters for rabies PEP are solely for delivery of subsequent rabies vaccine, which may unnecessarily strain ED resources and burden healthcare finances. Future research is needed to enhance instructions provided at ED discharge and to characterize patient-perceived barriers to rabies vaccine access in the community.