Information Technology-Assisted Screening for Gonorrhea and Chlamydia in a Pediatric Emergency Department

Area of Science:

• Public Health
• Infectious Disease Prevention
• Health Informatics

Background:

• Emergency departments (EDs) are critical settings for identifying and managing sexually transmitted infections (STIs) like gonorrhea and chlamydia (GC/CT).
• Adolescents and young adults are disproportionately affected by GC/CT, necessitating effective screening strategies within healthcare settings.
• Integrating screening tools into existing clinical workflows can improve efficiency and reach.

Purpose of the Study:

• To design and implement a novel, computerized clinical decision support (CDS) tool for GC/CT screening in the ED.
• To embed the screening tool within the ED clinical workflow, triggered by patient-entered data.
• To evaluate the tool's effectiveness in terms of patient capture, agreement to testing, and provider acceptance.

Main Methods:

• A tablet-based screening tool was developed based on qualitative data regarding adolescent and parent/guardian acceptability of GC/CT screening in the ED.
• The tool informed patients aged 14-21 about screening recommendations, explained the testing process, and assessed their agreement to testing.
• The system linked to CDS to streamline order entry, with primary outcome being patient capture rate and secondary outcomes including agreement to testing and provider acceptance.

Main Results:

• Patient capture rates were approximately two-thirds (64.6% and 64.5%) across main and satellite EDs.
• Patient agreement to GC/CT testing ranged from 4.4% to 9.9%.
• Provider ordering of tests for patients who agreed to testing was high (72-73%), and clinician CDS acceptance rates exceeded 70%.

Conclusions:

• The computerized CDS screening tool is a promising method for confidential GC/CT screening among youth in the ED setting.
• The tool demonstrated high patient capture and clinician acceptance rates.
• Additional interventions are necessary to enhance adolescent agreement for GC/CT testing.