163 - Sustainable Re-Implementation of Universal Sexual Health Screening in a Pediatric Emergency Department Using the PRISM Framework

Publication Number: 163.6859

Jane Alyce Hunt, Washington University in St. Louis School of Med, Saint Louis, MO, United States; Virginia Mckay, Washington University in St. Louis, St. Louis, MO, United States; Madeline Hendrix, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Fnu Shambhavi, Washington University in St louis, St Louis, MO, United States; Fahd A. Ahmad, Washington University in St. Louis School of Medicine, St. Louis, MO, United States

Background: Adolescents who use the emergency department (ED) for routine care are known to be at increased risk for sexually transmitted infections (STIs), regardless of the reason for the ED visit. Prior work has shown screening can identify infections, including asymptomatic infections, in these patients. We previously developed and implemented the adolescent questionnaire on sexuality (AQS) in our pediatric ED for this purpose. It uses a tablet-based questionnaire integrated into our electronic health record to obtain a sexual history and provide STI and HIV testing recommendations to the patient and ED clinician. While we had significant success in identifying STIs in at-risk patients, over time utilization decreased to less than 1% of eligible patients due to a variety of factors.

Objective: To demonstrate re-implementation of a universal sexual health screening program in a pediatric ED using the Practical Robust Implementation and Sustainability Model (PRISM).

Design/Methods: We assessed barriers and facilitators to AQS use through the Clinical Sustainability Assessment Tool (CSAT) and qualitative interviews with staff. We used PRISM as a framework to account for the factors and needs of the patients and organization for sustainable implementation. We used the CSAT and interview results to inform our re-implementation strategies. Our primary outcome measure was the proportion of eligible patients who completed the AQS. Secondary outcomes included proportion of patients at-risk for STIs and STI testing acceptance.

Results: The CSAT (n=33) identified the program’s beneficial health outcomes and cost-effectiveness as areas with high capacity for sustainability. Areas with opportunity for improvement were workflow integration and coaching staff. Key themes from interviews (n=9) were lack of dedicated team for the AQS, AQS usability, and the competing time demands of staff. In our first month of re-implementation, AQS completion increased from a baseline of < 1% to 18%. Among those completing the AQS, 32% were identified in the high-risk category and 17% opted in for some type of STI testing.

Conclusion(s): We identified determinants for successful AQS re-implementation and have seen early improvements in its use. Ongoing evaluation of implementation strategies to further increase AQS adoption and outcomes will support long-term sustainability and expansion to partnering EDs in our region.

PRISM Model Applied to the AQS
We applied the PRISM framework to the AQS with specific consideration of the recipients, infrastructure, and environment that support sustainable implementation of the program.