56 - Quality Improvement: Diagnosis and Treatment of Pelvic Inflammatory Disease in a Pediatric Emergency Department

Poster Number: 56
Publication Number: 56.407

Shaheen Andreas, University of Connecticut School of Medicine, East Lyme, CT, United States; Sharon Smith, Connecticut Children's Medical Center/UConn, Canton, CT, United States; Erica Lardieri, Connecticut Children's Medical Center, West Hartford, CT, United States; Alyssa S. Bennett, Connecticut Children's Medical Center, Hartford, CT, United States

Background: Adolescent females are at high risk for developing pelvic inflammatory disease (PID) which causes long-term sequelae including chronic pain, recurrent PID and lower genital tract infections, and infertility. PID is often misdiagnosed in the Emergency Department (ED).

Objective: The purpose of this study is to identify gaps in the identification and treatment of PID in a pediatric ED and to implement interventions to improve care.

Design/Methods: This quality improvement project conducted in a pediatric ED included adolescent females age 14 to 20 who presented with a chief complaint of vaginal symptoms, abdominal or pelvic pain. Exclusion criteria were patients without PID symptoms or received another diagnosis. Baseline data was collected from March 2019 through June 2019. Charts were audited by trained pediatric residents and reviewed by an adolescent medicine physician and pediatric emergency medicine fellow, with expertise in the management of PID. The baseline data included age, type of primary provider, gender of provider, STI testing, documentation of sexual history and bimanual exams, and antibiotic therapy. Initial educational interventions began in August 2019, followed by introduction of a best practice advisory (BPA) in the hospital's electronic medical record in November 2019, and confidential STI testing in August 2020.

Results: There were a total of 798 patients, mean age 16 (+/- 1.2). Residents were the primary provider for a majority of patients (53%), followed by midlevels, fellows and attendings. Sexual history was documented 71% of the time, with increasing documentation as patients aged. Documentation of sexual history was similar by race. In patients with unknown or positive sexual history, STI testing was obtained 22% of the time. Bimanual exams were offered in patients with unknown or positive sexual histories 15% (Nf70) of the time, with 25% of these being positive. 58% (Nf23) of patients were correctly diagnosed with PID based on the exam. 52% of patients who met criteria for PID were treated incorrectly. During the course of the project, sexual history documentation slightly improved but did not correlate with any specific intervention. STI testing and bimanual exams also improved slightly throughout the course of the project, with the largest impact coming after the EPIC BPA was initiated.Conclusion(s): Among adolescents presenting to a pediatric ED with symptoms concerning for PID, 46% received an appropriate history, exam, diagnosis and treatment of their chief complaint. Changes in electronic medical record alerts and testing had the greatest impact on provider change.
Shaheen Andreas CVAndreas Shaheen CV.pdf
Figure 2Run Chart on the performance of bimanual exams between March 2019 and May 2021