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Bridging Gaps in Congenital Syphilis Care: A Quality Improvement Initiative for Comprehensive Management at a Large
Diana D Villarreal1, Jessica Perez2, Mikhaela D Cielo1
1From the Department of Pediatrics, Maternal Child and Adolescent/Adult Center for Infectious Disease and Virology.
Insights
Rising congenital syphilis rates necessitate standardized infant care. A new pathway improved adherence to guidelines for evaluation, treatment, and follow-up, ensuring better infant outcomes.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Congenital syphilis incidence is increasing globally and in the USA.
- Standardized care is crucial for infants born to parents with syphilis.
- A local review identified significant gaps in adherence to national guidelines for infant syphilis management.
Purpose of the Study:
- To develop and implement a standardized care pathway for infants born to birthing parents with syphilis.
- To improve adherence to Centers for Disease Control and Prevention (CDC) guidelines for infant evaluation, treatment, and follow-up.
- To enhance risk stratification, treatment decisions, and postnatal care planning.
Main Methods:
- A quality improvement team developed the "Congenital Syphilis Pathway."
- The pathway incorporated Pediatric Infectious Disease consultations, provider education, and systematic outpatient follow-up scheduling.
- Interventions included targeted education sessions and consultations during the hospital stay for eligible infants.
Main Results:
- Pediatric Infectious Disease consultation rates achieved 100% post-implementation.
- Appropriate infant management adherence increased from 85% to 100%.
- Follow-up scheduling adherence rose from 54% to 91%.
Conclusions:
- A structured care pathway significantly improved adherence to congenital syphilis management guidelines.
- Key elements include standardized consultations, provider education, and systematic follow-up.
- Adaptable core components can enhance care in diverse healthcare settings.
Background:
Congenital syphilis rates are rising in the United States and globally, necessitating standardized care for infants born to mothers with syphilis. The Centers for Disease Control recommends comprehensive evaluation, treatment, and follow-up for these infants to ensure optimal outcomes.
Local Problem:
At Los Angeles General Medical Center, a retrospective review of 97 infants (2022-2023) revealed gaps in adherence to national guidelines, particularly in risk stratification, treatment decisions, and outpatient follow-up planning. Among 15 syphilis-exposed infants (2 unknown-risk, 4 high-risk, 9 low-risk), some received abbreviated or potentially inadequate treatment without a full evaluation, while others had treatment deferred without ensuring appropriate outpatient follow-up. These inconsistencies in postnatal management highlighted the need for a structured, multidisciplinary approach to improve adherence to best practices.
Methods:
A quality improvement team developed the "Congenital Syphilis Pathway" to standardize care and improve adherence to the Centers for Disease Control guidelines. The intervention included recommended Pediatric Infectious Disease consultation to improve risk stratification and treatment decisions, targeted provider education to enhance guideline adherence, and systematic scheduling of outpatient follow-up to ensure appropriate postnatal monitoring. The pathway aimed to achieve 90% compliance with recommended evaluation, treatment, and follow-up practices between January and June 2024.
Interventions:
The pathway recommended a Pediatric Infectious Disease consultation for all eligible infants during their hospital stay and included educational sessions on congenital syphilis management for key stakeholders at three points during implementation to reinforce protocol adherence.
Results:
The population included all infants born to mothers with syphilis at Los Angeles General Medical Center. Following pathway implementation in January 2024, Pediatric Infectious Disease consultation rates reached 100% by June 2024. Appropriate management improved from 85% at baseline to 100% in Q2 2024, while follow-up scheduling increased from 54% at baseline to 91% in Q2 2024.
Conclusion:
A structured care pathway integrating standardized consultations, provider education, and systematic follow-up planning significantly improved adherence to congenital syphilis management guidelines. While direct pediatric infectious disease consultation may not be feasible in all settings, the core elements of this intervention - standardized evaluation pathways, provider education, and public health collaboration - can be adapted to improve care in diverse health care environments.
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