Improving Sexually Transmitted Infection Screening in Inpatient Pediatric Patients

BACKGROUND: Sexually transmitted infections (STIs) are a group of infectious diseases that cause acute illness and lifelong health effects. Half of the diagnosed cases occur in adolescents and young adults, ages 15 to 24. The American Academy of Pediatrics and the Centers for Disease Control and Prevention provide guidelines for STI screening for sexually active adolescents. Despite this, screening rates in adolescents admitted to our hospital are low. The purpose of this study is to use quality improvement methodology to improve the percent of adolescent patients who had documentation of sexual histories from 49% to 69% and STI testing from 29% to 49%. METHODS: Eligible patients included adolescents ages 14 to 18 admitted to our hospital’s academic general pediatric service. After baseline data collection, we introduced a series of 6 interventions; percentages of sexual history documentation and STI screening were recorded monthly. Interventions included resident education on STI screening, history, and physical form prompts for sexual history documentation, “badge buddy” sexual history templates, faculty development, and an electronic medical record template. Data were interpreted by using statistical process control to show process change. RESULTS: Before the interventions, 48.7% of patients ages 14 to 18 had sexual histories documented; 29.1% of patients were tested for STIs. After interventions, there was a special cause variation resulting in new center lines of 67.1% and 49.1%, respectively. CONCLUSIONS: Simple interventions to normalize and standardize adolescent sexual history discussions cumulatively led to a significant increase in sexual history documentation and STI screening in an inpatient adolescent population.