REQUEST, RECORD, AND REPORT: A QUALITY IMPROVEMENT EFFORT TO IMPROVE PATIENT NOTIFICATION AND TREATMENT OF STIS IN A RESIDENT CLINIC

Purpose: In most states, minors have the right to consent to testing and treatment of sexually transmitted infections (STI) without parental consent. Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding t...

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Bibliographic Details
Published in:Journal of adolescent health 2019-02, Vol.64 (2S), p.S135
Main Authors: Davidson, Asha, Barratt, Michelle, Furbacher, Jacqueline, Beyda, Rebecca
Format: Article
Language:English
Subjects:
Adolescents
Answering machines
Chart reviews
Chlamydia trachomatis
Clinics
Consent
Gonorrhea
Medical education
Medical treatment
Notification
Permission
Quality control
Quality improvement
Quality management
Review boards
Sexually transmitted diseases
STD
Teenagers
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Summary:Purpose: In most states, minors have the right to consent to testing and treatment of sexually transmitted infections (STI) without parental consent. Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding the timeliness and consistency of STI notification and treatment for adolescent patients seen in our resident clinics. Notification was often complicated by inconsistent documentation of a confidential teen phone number, or alternatively, permission to notify the teen's parent. The aim of this project was to assess whether modifying the EMR would enhance physician documentation of pertinent contact information and improve the time to notification of positive STI results and treatment at our clinics. Methods: We conducted a retrospective chart review in a large, urban resident clinic from July 2013 - June 2016. A quality improvement (QI) initiative included modification of the clinic's electronic medical record (EMR) and training of faculty and residents. A confidential section was added to the existing adolescent note template in the EMR that addressed four questions related to STI notification. The questions included documentation of a confidential phone number, the preferred time to contact the teen, permission to notify a parent or guardian, and permission to leave a voicemail The QI intervention with EMR modification and training took place July 1, 2015. For analysis, the patients were divided into two groups: Pre QI and Post QI. One year of data was included in each group. Outcomes measures included the following: time to notification of any GC/CT result, time to notification of a positive GC/CT result, and percent documentation of the four questions in EMR. The institutional review board deemed this a quality improvement project. Results: We reviewed 157 charts to date: 108 Pre QI and 49 Post QI. The two groups were similar in demographics with 78% female Pre and 70% Post QI, average age 16.4 years (SD 2.7 years)Pre and average age 16.1 years (SD 1.6 years) PostQI. The sexually transmitted infections recorded included gonorrhea (GC), chlamydia (CT), or both. 15 patients (13.9%) tested positive to any STI in the Pre QI group. 5 patients (10.2%) tested positive to any STI in the Post QI group. The time to notify and treat patients Pre QI was 8.5 days (SD 12.7 days) versus 2.6 days (SD 1.7 days) Post QI (p value = 0.16). Additional analysis of the EMR question
ISSN:1054-139X
1879-1972