Presenter Status
Fellow
Abstract Type
QI
Primary Mentor
Dr. Melissa Miller
Start Date
15-5-2025 11:30 AM
End Date
15-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Problem Statement/Question:
Previous work improved clinician sexually transmitted infection (STI) testing behaviors, but overlooked treatment interventions needed to facilitate risk reduction, HIV and syphilis (RPR) testing, and STI retesting at three months—critical components that reduce morbidity and disease spread. We are not adhering to evidence-based STI care for adolescents who tested positive for STIs at the ED index visit.
Background/Project Intent (Aim Statement):
According to the Centers for Disease Control and Prevention (CDC), in 2023, over 2.4 million cases of RPR, gonorrhea (GC), and chlamydia (CT) were diagnosed; about half of reported cases were among adolescents and young adults aged 15 to 24 years. STIs can cause severe morbidity including infertility and cost $16 billion annually. The CDC recommendations for STI care following a positive test include risk reduction counseling, HIV and RPR testing, and STI retesting in three months. Because most STI results are not immediately available, follow-up clinicians contact adolescents with positive results after the index ED visit to create a treatment plan that includes risk reduction, HIV and RPR testing, and STI retesting in 3 months. Reinfection is common and can be addressed by retesting, but adolescents face care barriers because many lack insurance and/or medical homes. Currently the patients who test positive for GC and/or CT at the initial ED visit have a 21% rate of retesting at three months. There is an urgent need to improve care for adolescents who test positive for GC and/or CT in our ED. The aim of this QI project is to improve retesting completion in three months for adolescents aged 14 to 21 years who test positive for GC and/or CT from 21% to 50% by May 2025.
Methods (include PDSA cycles):
Our improvement team utilized QI tools. Our outcome measure was retesting for GC/CT three months after the initial test. Process measures that will be monitored are HIV and RPR testing in teens diagnosed with GC/CT (at index ED visit or in follow-up) and outreach nurse fidelity to STI education content by using a Cerner checklist for guidance. Interventions included: physician and outreach nursing education, nurse reminders, surveys to assess clinician knowledge and practices, and creation of a Cerner checklist. We tracked our performance on run charts and stratified our data by race and ethnicity.
Results:
Currently, we have one month of data and two patients diagnosed with GC. Our outcome measure performance did not significantly change (21%). Our process measure of utilization of the checklist is 50%. However, we completed only one PDSA cycle to date and plan to have more data by May 2025.
Conclusions:
We anticipate our Cerner checklist and continued engagement between physicians, nurses, and advanced nurse practitioners will result in improvement in STI care including retesting for GC/CT, testing for HIV and RPR, and standardizing counseling provided to adolescents. Collaborative effort will lead to further process measure changes and improvement in STI care in adolescents who test positive for GC/CT.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Improving Adherence to Evidence Based STI Care for Patients Who Tested Positive at ED Index Visit QI Project
Problem Statement/Question:
Previous work improved clinician sexually transmitted infection (STI) testing behaviors, but overlooked treatment interventions needed to facilitate risk reduction, HIV and syphilis (RPR) testing, and STI retesting at three months—critical components that reduce morbidity and disease spread. We are not adhering to evidence-based STI care for adolescents who tested positive for STIs at the ED index visit.
Background/Project Intent (Aim Statement):
According to the Centers for Disease Control and Prevention (CDC), in 2023, over 2.4 million cases of RPR, gonorrhea (GC), and chlamydia (CT) were diagnosed; about half of reported cases were among adolescents and young adults aged 15 to 24 years. STIs can cause severe morbidity including infertility and cost $16 billion annually. The CDC recommendations for STI care following a positive test include risk reduction counseling, HIV and RPR testing, and STI retesting in three months. Because most STI results are not immediately available, follow-up clinicians contact adolescents with positive results after the index ED visit to create a treatment plan that includes risk reduction, HIV and RPR testing, and STI retesting in 3 months. Reinfection is common and can be addressed by retesting, but adolescents face care barriers because many lack insurance and/or medical homes. Currently the patients who test positive for GC and/or CT at the initial ED visit have a 21% rate of retesting at three months. There is an urgent need to improve care for adolescents who test positive for GC and/or CT in our ED. The aim of this QI project is to improve retesting completion in three months for adolescents aged 14 to 21 years who test positive for GC and/or CT from 21% to 50% by May 2025.
Methods (include PDSA cycles):
Our improvement team utilized QI tools. Our outcome measure was retesting for GC/CT three months after the initial test. Process measures that will be monitored are HIV and RPR testing in teens diagnosed with GC/CT (at index ED visit or in follow-up) and outreach nurse fidelity to STI education content by using a Cerner checklist for guidance. Interventions included: physician and outreach nursing education, nurse reminders, surveys to assess clinician knowledge and practices, and creation of a Cerner checklist. We tracked our performance on run charts and stratified our data by race and ethnicity.
Results:
Currently, we have one month of data and two patients diagnosed with GC. Our outcome measure performance did not significantly change (21%). Our process measure of utilization of the checklist is 50%. However, we completed only one PDSA cycle to date and plan to have more data by May 2025.
Conclusions:
We anticipate our Cerner checklist and continued engagement between physicians, nurses, and advanced nurse practitioners will result in improvement in STI care including retesting for GC/CT, testing for HIV and RPR, and standardizing counseling provided to adolescents. Collaborative effort will lead to further process measure changes and improvement in STI care in adolescents who test positive for GC/CT.
