Editor’s note: Special thanks to the CHOP “Close Your Eyes, We’ll Immunize” (CYEWI) team for sharing their initiative this month. In particular, we want to thank Dr. Logan Grimes and Dr. Carol Pasquariello who contributed to this article on behalf of the CYEWI team.
Historically, vaccination of children has occurred where they routinely get medical care, but increasingly access to vaccines at other locations, such as pharmacies, school clinics, or even at home (e.g., FluMist Home), helps families who have barriers to access. Barriers can take the form of limited time, needle phobia, awareness of annual recommendations, and more. This month, we wanted to share a program at the Children's Hospital of Philadelphia (CHOP) that has increased influenza vaccination among children undergoing sedation or anesthesia.
The program, “Close Your Eyes, We’ll Immunize,” has been providing influenza vaccines to children undergoing sedation or anesthesia for other procedures since 2023. During influenza season, families receive information about the program as part of their preoperative communications. On the day of the procedure, staff revisits the opportunity for vaccination, assesses interest and identifies eligible patients. When families agree, the vaccination is then administered while the child is sedated.
For this month’s Technically Speaking, we talked with the team who started this initiative at CHOP, so other institutions can learn about and consider this model that reduces discomfort and anxiety associated with immunization while also reaching children who may have inconsistent access to routine preventive care — particularly those who may not otherwise see a healthcare provider during flu season.
How did this initiative start?
The program was inspired by the late Dr. Ron Litman, a beloved pediatric anesthesiologist and child health advocate, who encouraged the anesthesia community to leverage perioperative encounters to promote the overall health of every child. This message resonated deeply with Dr. Carol Pasquariello, particularly in the context of declining influenza vaccine uptake.
She convened a multidisciplinary team, including perioperative clinical teams, nursing staff, pharmacy, hospital operations, and revenue integrity services. While workflows were designed and implementation started relatively quickly, ongoing coordination across these groups has been essential to both successful implementation and sustainability.
What initial resources were available for the program, and what resources have you had to ask for over time?
The most important early resource was the enthusiasm and commitment of a multidisciplinary team united around improving patient care. Operationally, the program required relatively minimal additional support as responsibilities were distributed across existing workflows.
The most complicated aspect was ensuring reimbursement for vaccine administration in the perioperative setting. Understanding that reimbursement agreements existed for each surgical procedure prior to program initiation, we had to partner with billing specialists who had a more nuanced understanding of billing and reimbursement. For those patients where cost would have inadvertently been passed on to families, executive leadership provided financial safeguards, enabling program implementation.
How have you measured success?
Success has been measured primarily by the number of vaccines administered each season. In the 2025-2026 flu season, we delivered 2,054 influenza vaccine doses to children already undergoing sedation or anesthesia. Importantly, approximately one-third of families report that their child would not have otherwise received the influenza vaccine due to reasons including needle phobia, limited seasonal healthcare access, and vaccine hesitancy.
Notably, when families decline, in approximately half of cases, it is because the children already received their annual influenza vaccine. Sometimes, parents decline due to safety concerns or not wanting the vaccine given during the procedure.
Some children are being vaccinated against influenza for the first time, representing a meaningful expansion of protection. For children 6 months through 8 years of age receiving influenza vaccine for the first time, families are counseled that a second dose will be needed, and they are instructed to follow up with their child’s primary medical home or another vaccine provider. The intention for these cases is that the family would have increased confidence in influenza vaccination after successful receipt of the first dose.
What obstacles did the program have to overcome?
In addition to financial considerations, the program faces the broader challenge of declining vaccine acceptance. Despite strong interest, some eligible families continue to decline this opportunity.
While our team works to address concerns, time constraints in the perioperative setting can limit the opportunity for detailed discussions. Improving real-time vaccine counseling within this environment remains an ongoing area of focus.
What are next steps for the program?
Building on early success, we aim to expand the program’s reach and scope. Our current focus is on two areas for expansion.
- Bundling care for neurodiverse patients — We are currently exploring ways to better support children with certain neurodiverse conditions who may experience barriers to routine care, such as needle aversion or difficulty tolerating outpatient procedures. One potential strategy is to develop an automated process that identifies children already scheduled for procedural care who are also due for immunizations or routine laboratory testing, allowing these services to be coordinated and completed, when appropriate, during the same encounter.
- Offering additional vaccinations — We are also exploring the feasibility of offering additional immunizations, including RSV and COVID-19 vaccines, as well as developing pathways to support catch-up immunization for children who are not up to date. Key considerations include identifying which vaccines are best suited for this care model, ensuring appropriate timing with other clinical care, and minimizing any potential confusion between expected vaccine-related symptoms and symptoms related to the child’s underlying illness or recovery. With a strong infrastructure now in place, the program is well-positioned to thoughtfully expand while continuing to prioritize safety, clear communication with families, and coordination with each child’s broader care team.
How have families received the program?
Family responses have been overwhelmingly positive. For some, the program offers convenience — allowing vaccination to be completed without an additional visit. For others, it provides access to protection they might not otherwise pursue due to other barriers.
Any other wins?
Staff engagement has also been notable. Many perioperative team members, who historically have encountered influenza primarily in the context of illness, value the opportunity to contribute to preventive care, describing their participation as both meaningful and professionally rewarding.
Editor’s note: Special thanks to the CHOP “Close Your Eyes, We’ll Immunize” (CYEWI) team for sharing their initiative this month. In particular, we want to thank Dr. Logan Grimes and Dr. Carol Pasquariello who contributed to this article on behalf of the CYEWI team.
Historically, vaccination of children has occurred where they routinely get medical care, but increasingly access to vaccines at other locations, such as pharmacies, school clinics, or even at home (e.g., FluMist Home), helps families who have barriers to access. Barriers can take the form of limited time, needle phobia, awareness of annual recommendations, and more. This month, we wanted to share a program at the Children's Hospital of Philadelphia (CHOP) that has increased influenza vaccination among children undergoing sedation or anesthesia.
The program, “Close Your Eyes, We’ll Immunize,” has been providing influenza vaccines to children undergoing sedation or anesthesia for other procedures since 2023. During influenza season, families receive information about the program as part of their preoperative communications. On the day of the procedure, staff revisits the opportunity for vaccination, assesses interest and identifies eligible patients. When families agree, the vaccination is then administered while the child is sedated.
For this month’s Technically Speaking, we talked with the team who started this initiative at CHOP, so other institutions can learn about and consider this model that reduces discomfort and anxiety associated with immunization while also reaching children who may have inconsistent access to routine preventive care — particularly those who may not otherwise see a healthcare provider during flu season.
How did this initiative start?
The program was inspired by the late Dr. Ron Litman, a beloved pediatric anesthesiologist and child health advocate, who encouraged the anesthesia community to leverage perioperative encounters to promote the overall health of every child. This message resonated deeply with Dr. Carol Pasquariello, particularly in the context of declining influenza vaccine uptake.
She convened a multidisciplinary team, including perioperative clinical teams, nursing staff, pharmacy, hospital operations, and revenue integrity services. While workflows were designed and implementation started relatively quickly, ongoing coordination across these groups has been essential to both successful implementation and sustainability.
What initial resources were available for the program, and what resources have you had to ask for over time?
The most important early resource was the enthusiasm and commitment of a multidisciplinary team united around improving patient care. Operationally, the program required relatively minimal additional support as responsibilities were distributed across existing workflows.
The most complicated aspect was ensuring reimbursement for vaccine administration in the perioperative setting. Understanding that reimbursement agreements existed for each surgical procedure prior to program initiation, we had to partner with billing specialists who had a more nuanced understanding of billing and reimbursement. For those patients where cost would have inadvertently been passed on to families, executive leadership provided financial safeguards, enabling program implementation.
How have you measured success?
Success has been measured primarily by the number of vaccines administered each season. In the 2025-2026 flu season, we delivered 2,054 influenza vaccine doses to children already undergoing sedation or anesthesia. Importantly, approximately one-third of families report that their child would not have otherwise received the influenza vaccine due to reasons including needle phobia, limited seasonal healthcare access, and vaccine hesitancy.
Notably, when families decline, in approximately half of cases, it is because the children already received their annual influenza vaccine. Sometimes, parents decline due to safety concerns or not wanting the vaccine given during the procedure.
Some children are being vaccinated against influenza for the first time, representing a meaningful expansion of protection. For children 6 months through 8 years of age receiving influenza vaccine for the first time, families are counseled that a second dose will be needed, and they are instructed to follow up with their child’s primary medical home or another vaccine provider. The intention for these cases is that the family would have increased confidence in influenza vaccination after successful receipt of the first dose.
What obstacles did the program have to overcome?
In addition to financial considerations, the program faces the broader challenge of declining vaccine acceptance. Despite strong interest, some eligible families continue to decline this opportunity.
While our team works to address concerns, time constraints in the perioperative setting can limit the opportunity for detailed discussions. Improving real-time vaccine counseling within this environment remains an ongoing area of focus.
What are next steps for the program?
Building on early success, we aim to expand the program’s reach and scope. Our current focus is on two areas for expansion.
- Bundling care for neurodiverse patients — We are currently exploring ways to better support children with certain neurodiverse conditions who may experience barriers to routine care, such as needle aversion or difficulty tolerating outpatient procedures. One potential strategy is to develop an automated process that identifies children already scheduled for procedural care who are also due for immunizations or routine laboratory testing, allowing these services to be coordinated and completed, when appropriate, during the same encounter.
- Offering additional vaccinations — We are also exploring the feasibility of offering additional immunizations, including RSV and COVID-19 vaccines, as well as developing pathways to support catch-up immunization for children who are not up to date. Key considerations include identifying which vaccines are best suited for this care model, ensuring appropriate timing with other clinical care, and minimizing any potential confusion between expected vaccine-related symptoms and symptoms related to the child’s underlying illness or recovery. With a strong infrastructure now in place, the program is well-positioned to thoughtfully expand while continuing to prioritize safety, clear communication with families, and coordination with each child’s broader care team.
How have families received the program?
Family responses have been overwhelmingly positive. For some, the program offers convenience — allowing vaccination to be completed without an additional visit. For others, it provides access to protection they might not otherwise pursue due to other barriers.
Any other wins?
Staff engagement has also been notable. Many perioperative team members, who historically have encountered influenza primarily in the context of illness, value the opportunity to contribute to preventive care, describing their participation as both meaningful and professionally rewarding.