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

Objectives: The objective of this study was to determine if an ED-based electronic health record (EHR) Best Practice Alert (BPA) increased the ordering of expedited partner therapy (EPT) for sexually transmitted infections (STI) in adult patients.

Background: US EDs have reported increases in STI visits and positivity rates, mirroring record level increases in STI incidence in the general population. EPT is an evidence-based practice recommended by public health experts for treating sexual partners of STI patients. EDs typically evaluate patients for STIs without their sexual partner present, thereby providing opportunities for EPT. However, EPT is infrequently used in US EDs.

Methods: This pilot study was part of a quality improvement initiative conducted between August and October 2021 in an academic tertiary care ED located in the Midwest. An EPT BPA was randomly displayed in the EHR to clinicians when they empirically treated adult ED patients for STIs with antibiotics. Differences in proportions of EPT ordering were calculated for STI visits between BPA exposed vs. unexposed, ED clinician type, and testing-confirmed vs. not confirmed STI status.

Results: Of the 52 adult ED patients empirically treated for STIs during the study period, their mean age was 30 years old, 56% were female, 48% White and 40% Black, and 31% had Medicaid. Testing-confirmed STI prevalence was 27%. EPT was ordered less often during BPA unexposed (8%; 95% CI 1-25) than BPA exposed (42%; 95% CI 23-63) STI visits, for a mean difference of 35% (95% CI 13-56). EPT was ordered during 41% of STI visits involving residents, as compared to 7% of physician assistant visits (p=0.07). EPT was not ordered more often for testing-confirmed vs. not confirmed STI visits (21% vs. 26%; p=0.7).

Conclusion: Displaying an EHR BPA greatly increased EPT ordering for patients empirically treated for STIs, although not consistently across all clinician types. Because suspected cases of STIs may be less common in some EDs depending on the populations they serve, BPAs may be a useful tool to bolster the implementation of EPT practices.