Background:
Due to increasing demands and dwindling resources, STI clinics must increase efficiency and still deliver quality care. In this environment, the greatest amount of resources should be devoted to those at highest risk for STI and their sequelae.

Objective:
To evaluate the ongoing evolution of triage system based on patients' risk, offering limited services to those at low risk.

Method:
The Denver Metro Health Clinic introduced the “express visit” (EV) for low-risk patients in 2004 and expanded this service to reduce impact on patient volume during the transition to an electronic medical record system in March, 2005. EV is comprised of urine testing for chlamydia and gonorrhea, HIV rapid testing, and RPR. This report on fully implemented system includes an 18 month time frame (January 2006 – June 2007).

Result:
A total of 18,433 visits were evaluated. Of these, 5,455 (29.5%) were EV. The proportion of EV was similar for women (26.1%) and men (31.7%) though female EV has decreased by 5% since inception. Chlamydia rates among women who had EV were 8% (121/1531) compared to 13% (603/4622) for regular visits. Among men, these rates were 8% (254/3187) and 16.6% (1214/7316) respectively. The rate differential between EV and regular visits for gonorrhea were 1.2% (18/1531) and 4.4% (203/4622) for women and 0.7% (21/3187) and 8.4% (618/7316) for men.

Conclusion:
Based on rates of the two most common curable STI, risk-based triage appeared to effectively identify those at highest risk for STI. The prevalence of chlamydia in those having EV was still sufficiently high to warrant screening. Our triage system continues to evolve based on clinic experience and testing outcomes.

Implications:
A triage system of determining patient risk and need, along with creative use of unlicensed personnel, is an efficient method for an STD clinic to use to maintain quality care in the face of decreasing resources.