Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Pediatric emergency departments (PEDs) and general EDs in the United States (U.S.) do not consistently deliver sexually transmitted infection (STI) care that aligns with clinical guidelines. To inform the development of an implementation strategy plan aimed to improve STI care in a PED, we interviewed PED nurse and physician stakeholders to identify challenges and corresponding potential solutions aimed to improve STI care in a PED.

Methods: We conducted semi-structured interviews with 27 stakeholders consisting of emergency medicine (EM) residents, pediatrics residents, pediatric EM (PEM) fellows, attending pediatric emergency physicians, and PED nurses at an academic urban PED. Using the Tailored Implementation in Chronic Diseases (TICD) framework, we prepared semi-structured interview guides specific to stakeholder roles structured according to the usual six successive workflow stages of STI care in the PED (triage, history-taking, physical examination, testing, treatment, and follow-up). Questions concerned current practices on providing STI care, challenges encountered, and potential solutions. Interviews were transcribed and analyzed using rapid content analysis. Responses were coded independently by two reviewers and categorized by TICD determinant domain.

Results: Participants identified multilevel implementation challenges across the stages of STI care in the PED. Structural challenges included lack of privacy and limited private exam rooms, inadequate STI-related workflows, and inadequate waiting areas. Procedural challenges included the following: nonstandardized triage protocols; unclear role delineation; confusing sample collection procedures; insufficient training in STI examination, testing, and treatment procedures; variable documentation practices; and difficulty ensuring follow-up. Suggested solutions included development of role-specific STI protocols, smart phrases for documentation, improved sample-labeling procedures, prepackaged medications for empiric treatment, and embedded referral pathways to an adolescent care clinic.

Conclusion: Using the TICD framework, this study identified key challenges, such as gaps in training, protocols and transition of care, and corresponding stakeholder-informed solutions to improve adolescent care for STIs in a pediatric ED setting. These findings can guide efforts to implement evidence-based STI practice guidelines in PEDs and general EDs.