Improving Documentation Leads to Improve Screening for Sexually Transmitted Infections (Stis) Screening for Adolescents in Pediatric Inpatient Units

Background:

The Center for Disease Control (CDC) and US Preventative Services Task force recommend screening of all females younger than 25 years annually. The CDC estimates about 20 million cases of sexually transmitted infections (STIs) diagnosed annually in the United States. Adolescents carry majority of burden. The most common complication of untreated Chlamydia is pelvic inflammatory disease, which can lead to life-long problems including chronic pelvic pain and infertility. Many adolescents do not attend preventative visits with their primary care doctors and frequently rely on emergency medical care. Thus, it is very imperative  to screen adolescents routinely as this may be only interaction with medical providers.  The objective of this project is to improve appropriate screening of STI’s via improvement in documentation.

Methods:

A standard STI form is conveniently incorporated in our History and Physical documents in the electronic medical chart. For the purpose of this abstract, we included adolescents older than 13 years old who were admitted in IU between January to November 2015. For our baseline data, we analyzed 16 charts. Our first intervention was done by using an E-mail reminder to all members of the house staff rotating in the IU to meticulously screen adolescent patients via documentation in April 2015. A chart review was conducted for 22 patients from April to August 2015 (Cycle 1).  We further intervened by emailing, posting an algorithm¹in conference room, and in-person announcement among residents who rotated in the IU from September to November 2015 (Cycle2). After the second intervention a total 12 patients were identified and analyzed.

Results:

Pre-project data showed that STI screening tests were documented in only 6% (1/16) of inpatient admission to IU. After the first intervention, STI screening documentation rate was increased to 41% (9/22) within 5 months (Cycle 1).  After the second intervention, the documentation rate was significantly increased to 83% (10/12) within 3 months (Cycle 2). Of those screened 38% (13/34) were tested for STI testing and 1 out of the 13 laboratory tests was positive for gonorrhea

Conclusions:

Data from two Plan-Do-Study-Act (PDSA) cycles regarding resident’s STI screening documentation suggest an improvement in appropriately ordering tests for STI screening. After educating pediatric residents every month using several educational tools, STI screening documentation rate was significantly improved. Continuous education for residents regarding accomplishing an STI screening documentation will most likely lead to improve STI screening for adolescent and may positively impact  patient health outcome.