Hospital intervention increased STI testing among at-risk adolescents
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Key takeaways:
- In 14 months, a hospital increased its STI testing rate among high-risk patients from 12% to 59%.
- The interventions included creating preselected orders in the electronic medical record.
A hospital in California increased testing for chlamydia and gonorrhea among high-risk adolescents by nearly fivefold in its pediatric ED by implementing several interventions, including preselected order panels for physicians and nurses.
“We know that adolescents are a more high-risk population in general. They tend to have high-risk behaviors, including high-risk sexual activity, which can lead to sexually transmitted infection,” Tatyana Vayngortin, MD, an emergency medicine physician at Rady Children's Hospital in San Diego, told Healio.
“The AAP recommends screening adolescents for STI, but often, they don't always access primary care and they're more likely to seek care in the emergency department,” Vayngortin said. “We know that teens who present to the emergency department are also a more high-risk population.”
The situation worsened during the COVID-19 pandemic, which complicated access to care, Vayngortin said.
“For public health screenings, we want to identify STIs early to prevent spread but also to prevent chronic complications because untreated STIs can lead to infertility and chronic pain later on,” Vayngortin said.
Vayngortin and colleagues began by examining 6 months of ED data to assess which patients in the ED were at highest risk for STIs.
“We found three main categories of at-risk patients,” Vayngortin said. “This included patients with genital urinary complaints — such as pain with urination, or vaginal pain or bleeding — females with abdominal pain, and behavioral health complaints, such as depression or suicidal ideation.”
The researchers targeted these three groups with interventions that included providing educational interventions on STI testing and treatment to physicians and nurses, creating order sets in the electronic medical record, allowing nurses to initiate orders for tests, and in what Vayngortin called the “most meaningful intervention,” creating preselected orders.
“When any of these patients with those complaints I mentioned came into the ED, they automatically had chlamydia and gonorrhea testing ordered,” Vayngortin said.
The educational interventions and querying for phone numbers and sexual histories were not as successful, Vayngortin said, but having preselected orders did help increase testing.
Within 14 months, the proportion of at-risk patients tested increased from 12% to 59%. Phone number documentation remained unchanged from 23%, and sexual history documentation remained unchanged from 46%.
The number of patients who received positive test results increased from 1.8 to 3.4 per month, and the proportion of patients testing positive who were contacted to arrange treatment also remained unchanged, at 83%.
Additionally, the researchers found that a third of positive chlamydia and gonorrhea tests were in patients with behavioral health issues, which Vayngortin said they have since used to identify more positive screens within the ED.
“These weren't patients [who] were necessarily coming in for, you know, urinary complaints, or vaginal or female complaints,” Vayngortin said. “They were coming in for unrelated behavioral health complaints, such as depression, anxiety, suicidal ideation, or aggressive behavior. After this project was implemented, we started screening all the behavioral health patients, and we really identified that to be a high-risk population.”
Further research is still warranted to help the reproductive health needs of adolescents, Vayngortin said.
“We found that with our quality improvement interventions, and really standardizing the testing with these preselected orders, we could reduce some of those inequities in testing,” Vayngortin said.
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