388 - Assessing the Feasibility of Patient-Facing Electronic Sexually Transmitted Infection (STI) Screening in an Urban Pediatric Emergency Department
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 388 Publication Number: 388.406
Danielle Foltz, Children's National Health System, Washington, DC, United States; Monika Lemke, Children's National Health System, Westminster, MD, United States; Laura C. Schubel, MedStar Health Research Institute, Washington, DC, United States; Deanna Busog, MedStar Health, Bowie, MD, United States; Azade Tabaie, MedStar Health Research Institute, Washington, DC, United States; Gia M. Badolato, Children's National Health System, Washington, DC, United States; Kristen E. Miller, MedStar Health National Center for Human Factors in Healthcare, Washington, DC, United States; Monika Goyal, Children's National Medical Center, Washington, DC, United States
Clinical Research Assistant Children's National Health System Washington, District of Columbia, United States
Background: Adolescents seeking care in emergency departments (EDs) are at risk for sexually transmitted infections (STIs).The ED visit offers a strategic venuefor broad-scale screening and treatment butoptimization of STI screening requires thoughtful investigation of clinician workflow, patient acceptance, and integration into the electronic health record (EHR). Objective: To understand how use of electronic questionnaires integrated into the EHRto drive patient-centered sexual healthcare can be effectively implemented inthe ED. Design/Methods: We applied a human factors frameworkto develop a process for broadscaleSTI screening in a pediatric ED.This mixed methodsapproach included stakeholder interviews and clinical observations that were conducted as part of a larger study addressing racial and ethnic inequities in STI detection and treatment. Thematic analysis of interview responses and observational findings was used to create workflow models, process maps, and recommendations for STI screening implementation. Results: Thirty stakeholder interviews were conducted with an interdisciplinary group, including patients, caregivers, physicians, nurses, health information technology (health IT) experts, social workers, child life specialists, and registration staff. Interviews were conducted until thematic saturation. Twenty ED workflow observation sessions (80 hours total) were completed across five stakeholder groups (patients, caregivers, physicians, nurses, and registration).
The stakeholder interviews revealed general acceptance of STI screening in the ED but expressed concerns about the logistics given persistent challenges in staffing and patient surge. Identified barriers to screening included privacy; sensitivity of the topic; patients’ level of comfort in using technology and answering questions about their sexual history; language and literacy barriers; staffing concerns; cognitive overload of health providers; and tablet availability and security.
Workflow observations revealed implementation of the STI screening at the point of triage, where ED patients are assessed to determine acuity and chief complaint, as the recommendation.
Conclusion(s): This study highlights a rigorous process for assessing the feasibility and acceptability of broadscale STI screening in the pediatric ED and provides a recommendation for implementation. Our researchprovides insight for barriers to future health ITintegrations in ED workflows and could be used to drive design and implementation strategies for other patient-centered initiatives.
.jpg "Danielle Foltz, BA (she/her/hers) photo")
