Improving Notification of Sexually Transmitted Infections: A Quality Improvement Project and Planned Experiment

Abstract

BACKGROUND AND OBJECTIVE: Inadequate follow-up of positive sexually transmitted infection (STI) test results is a gap in health care quality that contributes to the epidemic of STIs in adolescent women. The goal of this study was to improve our ability to contact adolescent women with positive STI test results after an emergency department visit. METHODS:We conducted an interventional quality improvement project at a pediatric emergency department. Phase 1 included plando-study-act cycles to test interventions such as provider education and system changes. Phase 2 was a planned experiment studying 2 interventions (study cell phone and patient activation card), using a 2 3 2 factorial design with 1 background variable and 2 replications. Outcomes were: (1) the proportion of women aged 14 to 21 years with STI testing whose confidential telephone number was documented in the electronic medical record; (2) the proportion of STI positive women successfully contacted within 7 days.RESULTS: Phase 1 interventions increased the proportion of records with a confidential number from 24% to 58% and the proportion contacted from 45% to 65%, and decreased loss to follow-up from 40% to 24%. In phase 2, the proportion contacted decreased after the electronic medical record system changed and recording of the confidential number decreased. Study interventions (patient activation card and study cell phone) had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented.CONCLUSIONS: Feasible and sustainable interventions such as improved documentation of a confidential number worked synergistically to increase our ability to successfully contact adolescent women with their STI test results. Pediatrics 2012;130:e415-e422 AUTHORS:

Point-of-care testing improves accuracy of STI care in an emergency department

“…The prevalence of STIs in this population is high: 8% have NG and 15% have TV 15. Because of the high volume and high prevalence in the ED, we implemented a quality improvement (QI) project to improve follow-up care for adolescent women diagnosed with an STI.…”

Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection

“…5,13 Recently, we showed that we can improve our ability to contact women with their STI test results, and reduced our lost to follow-up rate from 40% to 24%. 3 Thus, timely followup of positive STI results is a necessary public health intervention for adolescent women utilizing the ED.…”

“…3 This data was obtained in a busy, urban ED with a high volume of adolescent visits and a high prevalence of STIs. We identified a cohort of all female patients ages 14-21 who were tested for STIs in the ED between January and October 2009.…”

“…The initial quality improvement study included periods of both unidirectional (the ED contacted the patients), and bidirectional (patients can also contact the ED) contact methods. 3 During the study period, the nurse practitioner attempted to contact all patients testing positive for STIs, regardless of whether or not they received empiric treatment at the ED visit. The nurse developed a treatment plan for each patient who was positive and not initially treated at the ED visit.…”

“…1,2 At our institution's ED, approximately 100 women are tested monthly for STIs and approximately 22% tested are positive for at least 1 curable STI (CT, GC, or trichomoniasis vaginalis (TV)). 3 Thus, we expect that strategies to improve STI care in our ED will have a significant impact on our community's STI epidemic.…”