Emergency department Chlamydia screening through partnership with the public health department

The emergency department (ED) serves a population that may benefit from numerous screening initiatives but screening in the ED is challenging due to crowding as well as resource and time constraints. One option may be to collect specimens in the ED and then partner with the public health department (PHD) to analyze the specimens off-site and arrange follow-up treatment.

The objective was to explore the feasibility of chlamydia screening in females using a partnership model in which the ED is responsible for urine collection and the PHD is responsible for chlamydia testing, notification, and treatment.

A collaborative partnership-based chlamydia screening project was initiated at a large (90,000 visits/yr), urban, teaching ED from April 2007 to April 2008. Study information sheets were handed out to a convenience sample of eligible female patients and visitors (15-24 yr of age). Those wishing to participate provided a urine sample and follow-up contact information. The information sheet also asked if they had either lower abdominal pain or vaginal discharge (affirmative answer for either was considered symptomatic). Specimens collected in the ED were retrieved by PHD staff for off-site testing. The PHD contacted those participants testing positive using the patient provided contact information and arranged for treatment.

Of the 633 women offered screening, 296 (47%) agreed to testing and provided samples. Of the 296 tested, 38 (12.8%) were positive for chlamydia infection, and 25 (66%) received follow-up and treatment; 13 could not be contacted through information they provided. A higher percentage of symptomatic subjects (23 of 115, or 20%) tested positive for chlamydia than asymptomatic subjects (15 of 181, or 8.3%; p < 0.01).

This study demonstrates the feasibility of an ED-PHD partnership for chlamydia screening in young women. This model can potentially be applied to other initiatives and may improve public health screening without creating significant additional burdens for crowded EDs.