Food and Drug Administration–authorized COVID-19 vaccinations arrived at most essential hospitals in mid-December. Amid delayed vaccine arrivals, shifting state guidelines, and long lines, the rollout has been challenging.

Texas, home to seven association members, was one of the first states to open vaccinations to the public. Beginning Dec. 28, the state entered its phase 1B of vaccination, prioritizing people age 65 and older and people ages 16 to 64 who have a chronic medical condition that puts them at increased risk for severe illness from COVID‑19.

Zen Bond (center) receives her injection of the Moderna COVID-19 vaccine Jan. 4 at the Wonderland of the Americas during the first day of vaccinations provided by University Health for community members 65 or older and those with certain underlying health conditions. Photo by Mark Greenberg.

University Health, in San Antonio, has vaccinated an average of 1,500 community members per day since Jan. 4, using both the Moderna and Pfizer vaccines, depending on availability. As of Jan. 24, University Health had provided more than 44,000 vaccine doses, more than 36,000 of which were first doses, to older adults and people with chronic conditions, as well as health care workers, emergency responders, and other especially vulnerable populations. University Health leaders share their key takeaways from this essential hospital’s vaccine distribution experience.

Community partners are key. Health system leaders provided their first vaccine shots to front-line health care workers and first responders throughout the community. University Health then became the first large-scale community provider in the San Antonio area by opening a vaccination center in a local shopping center with ample parking and proximity to public transportation, providing vaccinations to seniors and adults with chronic medical conditions.

The health system now is coordinating with the City of San Antonio’s public health department and a private provider to expand availability of COVID-19 vaccines throughout the community. The three providers all receive vaccine allotments from the state and work to ensure each has enough vaccine to inoculate everyone with a scheduled appointment. The number of people who can be scheduled for their shots depends on the amount of vaccine provided by federal and state governments. So far, the number of people who want to be vaccinated far outstrips the allotment provided.

Photo by Mark Greenberg.

Dorothy Cisneros, 71, receives her COVID-19 vaccine Jan. 4. Photo by Mark Greenberg.

Prioritize vaccination for front-line workers and groups that can, in turn, vaccinate others. University Health has prioritized first responders and other eligible essential workers, including bus drivers and school district personnel. The health system also has prioritized school nurses, with the hope they can, in turn, vaccinate teachers and other school staff members on the front lines.

Preregistration is critical. To minimize the amount of time people spend at the vaccination site, University Health offers online registration with a form created through the Epic electronic health record system. Health system leaders have seen incredible demand for vaccines. In the first five hours after registration initially opened, more than 17,000 people signed up and filled all the available appointments. The second time the website opened with available appointments, 24,000 slots were filled in three hours and 15 minutes. By offering preregistration for vaccinations, health system leaders can efficiently organize check-in, documentation, and administration of the shots.

During the first two weeks of operation, the health system scheduled 10 appointments every five minutes from Monday through Saturday, 8 am to 8 pm. The medical team vaccinated an average of 120 people each hour and approximately 1,500 each day. Staff at the vaccination site check in individuals with an iPad when they arrive and encourage them to sign up through Epic for MyChart, the health system’s patient portal. That ensures they receive reminders about their second vaccine doses.

University Health EPIC team member Rebecca James educates vaccine recipients about signing up for the University Health MyChart app. Photo by Mark Greenberg.

Learn and course correct in real time. Using lessons learned every day, University Health leaders continue to fine-tune their vaccination strategy. On the first day, people arrived hours in advance for their appointments, crowding the vaccination site. To minimize crowds, health system staff then called vaccine recipients a day in advance to confirm their appointments and urged recipients not to arrive early. By the second day of vaccination, there were no lengthy lines. It typically takes an average of 20 minutes from the time of arrival until a scheduled person receives their shot and departs.

Plan for the future. The health system is currently targeting vulnerable patients, including members of its CareLink financial assistance program for uninsured Bexar County residents who meet the current 1B criteria. University Health also is exploring mobile vaccination units to reach other areas, as well as partnerships to expand vaccinations to community members.

University Health also has begun to schedule appointments several weeks in advance, even though the state of Texas only confirms the amount of vaccine the health system will receive on a weekly basis.

“We understand the tremendous anxiety in the community regarding COVID-19 vaccine shortages and the difficulty in making a vaccination appointment,” says George Hernández, president and CEO of University Health.

Scheduling several weeks in advance assures people that they have a scheduled appointment, subject only to the vaccine shipment quantity. Because these appointments depend on University Health receiving the COVID-19 vaccine from the state, the health care system will confirm receipt of the vaccine each week. People with scheduled appointments are urged to check the website the Friday before their appointment to verify that the hospital has received adequate vaccine supplies. University Health also notifies the public about vaccine totals weekly through social media and news media.

“We believe this two-step process will help us continue to efficiently vaccinate as many eligible people as possible while reducing the stress caused by the high COVID-19 vaccination demand,” says Hernández.

Bill Phillips, senior vice president and chief information officer, led the team that designed the vaccine center operation. He says there have been a lot of 12-hour days for many staff, but the work has been rewarding.

“I can’t tell you how many people want to hug us, thank us when they receive their vaccinations. They’re so grateful. They feel we saved their lives,” Phillips says.

To learn more about University Health’s COVID-19 vaccine distribution experience, join us for a members-only webinar, COVID-19 Vaccinations: University Health’s Strategy, Feb. 3, at 2 pm ET.