Dane Snyder, MD, thinks most parents are comfortable vaccinating their children. They just want the process to be convenient.
Snyder, section chief of primary care and medical director of ambulatory services at Nationwide Children’s Hospital, and his team turned to technology and streamlined in-room practices to make vaccination a simple choice.
Updating outreach
While vaccines are offered at every type of appointment, most are given during well visits. But getting children in for routine check-ups can be challenging. New parents may be overwhelmed by what feels like an avalanche of well visits in the first two years of life; there are seven appointments between birth and 15 months.
In 2018, well visit adherence rates were 38% for infants in this age range who received care through Nationwide’s network of providers. Updating outreach methods helped the hospital increase the percentage of infants who complete the early childhood well visit series. In 2025, 62% complete the series, in alignment with national guidelines.
Snyder said the team stopped using mailings and postcards for reminders and switched to a text message system.
“We built an algorithm, and every month, a patient got a text message if they were behind on their well visit from 2 to 9 months old,” Snyder said. “Within that text message, they could click the phone number and call. We had a 25-30% success rate getting those patients scheduled, which really helped a lot.”
Scheduling strategies
Snyder’s team also instituted slight shifts once patients are in the office. For example, rather than waiting until the end of an appointment, staff members offer to schedule well visits at check-in.
“Sometimes after a visit, there’s a line. Sometimes patients would forget. But when we scheduled during the check-in process, the rates of well visit adherence increased tremendously,” Snyder said. “This process also helps with patient-provider continuity, which is a tough thing to do in academic centers.”
Snyder says scheduling in advance–rather than having a parent call to schedule a week or two before–means patients are more likely to see the same provider. Working with the same provider has been shown to increase appointment adherence rates and decrease emergency department visits.
Timing is everything
Tweaking protocols for elective vaccines has also proved successful. Nationwide implemented two methods to encourage uptake of the HPV vaccine: starting the series earlier and offering it at the beginning of the visit.
Instead of waiting until age 11 for the HPV series, the team now offer the first shot at 9-year well visits.
“Traditionally, we didn’t start offering this until age 11, but this gives us a longer runway to complete the series by the time they turn 13,” Snyder said.
Another factor is when the vaccine is offered during the visit. Typically, the clinician recommends vaccines near the end of the visit, with the disclaimer that the HPV vaccine requires 15 minutes of observation to ensure no reaction. If parents weren’t able to wait, they would turn down the vaccine.
Now, nurses offer the HPV vaccine alongside other adolescent vaccines during the rooming process. If the patient accepts, the observation period is conducted during the visit.
“This increased our acceptance rate and improved clinic flow,” Snyder said. “It doesn’t take up an extra room for 15 minutes or send someone out into the lobby to wait. It’s been good for vaccine acceptance, length of stay in the clinic, flow, throughput, everything.”
Since changing when they began offering the HPV vaccine, the number of children who have completed the series increased from 25% to 65%.
Snyder said vaccine acceptance can be more about convenience than hesitancy, so it’s important to find better ways to connect and make the clinic and patient experience seamless.
