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

Background: 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.  

Objectives: To improve our ability to contact adolescent women with a positive STI test result following an Emergency Department (ED) visit.  

Methods: Interventional quality improvement project set in an urban pediatric ED: Phase 1 used plan-do-study-act cycles to test individual interventions. Phase 2 was a planned experiment using a 2 x 2 factorial design with one background variable and two replications. Outcomes: Of women age 14-21 with STI testing, we measured the proportion with a confidential number documented in the electronic medical record (EMR). For STI-positive women, we measured the proportion successfully contacted within 7 days and the proportion lost to follow-up (not contacted within 30 days). Analyses utilized Shewhart control charts and graphical displays.  

Results: Phase 1 interventions increased the proportion of records with a confidential number from 25% to 58%. Simultaneously, the proportion successfully contacted increased from 45% to 65%, and loss to follow-up decreased from 40% to 24%. In phase 2, there was an interaction between replications and successful contact that coincided with a change in EMR systems and decreased recording of the confidential number. In addition to the confidential number, two interventions improved contact success: giving a patient activation card and using a designated cell phone for follow-up calls. These interventions had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented.

Conclusions: Low-cost, system level interventions are feasible and sustainable in a busy ED, and work together to improve our ability to contact adolescent women with their STI results in a timely fashion.

Implications for Programs, Policy, and Research: Post-visit interventions may decrease the risk of reinfection and disrupt STI transmission.