Approximately 3,000 people are tested for gonorrhea and chlamydia in the Barnes-Jewish Hospital emergency department (ED) each year, and until recently 70-80% were lost-to-follow-up. A number of factors contributed to this high rate, including the lack of a robust mechanism in the ED for follow-up care and incorrect contact information.
With funding from the Barnes-Jewish Hospital Foundation, Dr. Hilary Reno is directing a study that is testing methods to decrease the lost-to-follow up rates for patients who test positive for gonorrhea (GC) and chlamydia (CT) in the ED.
Here is how the study works: whenever a patient is tested for GC and CT in the ED, the test triggers a page to a ED Research Core assistant who administers a survey to the patient, requesting information about why they chose to utilize the ED as well as a confidential phone number where they can be reached with their test results. Meanwhile, behind the scenes, each of these tested visits is tagged and pulled from the electronic health record database into a REDCap database for Dr. Reno to review. She quickly identifies visits that were positive for GC and/or CT, and together with the contact information collected during the visit, attempts to follow up with every positive patient within days of their visit. She can prescribe them treatment, as well as prescribe treatment for their partners (expedited partner therapy) if the patient has chlamydia.
REDCap is a secure web application for building and managing online surveys and databases developed at Vanderbilt University. Staff from the Institute for Public Health’s Public Health Data and Training Center (which houses and serves as data management support for many of Dr. Reno’s projects) partnered with BJC HealthCare’s Center for Clinical Excellence (which houses patient data) in working with REDCap staff to establish the live feed and connections. The information on each patient includes their name, contact information, and details from their visit. The database is updated every day.
In the first month, among tested patients who gave a confidential phone number in the ED, the lost-to-follow up rate dropped to 25%. Dr. Reno speculates that the mechanism at play here is not the valid phone number itself, but the fact that the request for the number prompted the patient to expect a phone call from an unrecognized phone number within a few days of their ED visit.
In addition to that success, the database and improved follow up has helped the ED roll out a new test for trichomoniasis, another sexually transmitted infection, which is now also being captured in the REDCap database. ED administrators heard about Dr. Reno’s project and were motivated to begin using the new test once they knew a mechanism for follow-up was in place.
“Tackling the high rates of STIs in the St. Louis Region is complex. Improving our existing systems to ensure patients with proven STIs get their test results and the best prevention messaging will hopefully lead to improved practices throughout the region,” said Dr. Reno.
She added, “It is important that this process is sustainable beyond the study period. After the study is completed this summer, our next step will be to have contact information requested from the patient at discharge and entered into the ED note. Then the follow-up nurses, with the information from the REDCap database, will be able to reach more patients.”