B-126 Implementation of a Labor and Delivery Syphilis test to improve workflow for ACOG practice advisory compliance
Year: 2025
Type: conference-abstract
Abstract: Background Congenital syphilis (CS) is a sexually-transmitted infection (STI) transmitted to an infant during pregnancy or delivery from a syphilis-infected mother. In the United States, CS increased 1021% in a decade from 335 cases in 2012 to 3755 cases in 2022. In response, the American College of Obstetricians and Gynecologists (ACOG) issued a practice advisory in April-2024 to screen an expectant mother for syphilis three times: at the first encounter, at 28 weeks of pregnancy, and at the time-of-delivery. This is a 3-fold testing-increase from prior guidelines, which only required a single prenatal syphilis screen. In our institution, prior to the new ACOG practice advisory, syphilis testing was performed during business-hours M-F, with no laboratory-scientists staffed over the weekend. With the increase of time-of-delivery syphilis testing from labor & delivery (L&D), a new workflow was needed in order to adequately treat/discharge mothers/infants seven-days-a-week. Here we describe the implementation of the L&D syphilis test to separate out L&D-ordered tests to comply with the ACOG practice advisory, evaluate test adoption, volumes, and positivity rates when compared to the conventional M-F syphilis test. Methods Our institution utilizes the reverse-algorithm for syphilis testing, with a Syphilis Total Antibody assay (Bioplex 2200, Bio-Rad, Hercules, CA) reflexing to an RPR card (Arlington Scientific, Springville, UT) and a TPPA reference-laboratory send-out. We created an orderable syphilis test specifically for L&D to more easily identify samples that need to be tested on weekends. This allows for a single laboratory-scientist to perform weekend-testing for the L&D-ordered samples for a short two-hour shift. This orderable test went live in September-2024, and we have reviewed the number of ordered tests for both the conventional-syphilis-test and L&D syphilis test between September-2024-to-January-2025, and analyzed the positivity-rates for both tests. We compared this to the positivity-rates of the conventional-syphilis-test from January-2024-to-August-2024. Results Since introducing the new L&D syphilis test in September-2024, orders increased from 7 (September) to 93 (October) and ranged between 195-228 for the following three months (November-2024-though-January-2025). Conventional-syphilis-orders averaged 1300-tests-per-month from September-2024-to-January-2025 (range:1135-1472); after averaging 1221-tests-per-month from January-2024-to-August-2024 (range:1095-1480). The average monthly positivity-rate from September-2024-to-January-2025 averaged 1.0% (range:0-3.2%) in the L&D population, while the conventional-test-population positivity-rate averaged 4.8% (range:4.4-5.1%) over the same timeframe. This average monthly positivity-rate is not significantly different than that from January-2024-to-August-2024 (average:4.6%, range:3.6-6.2). Most importantly, we have been able to report an average of 27 (range:10-38, October-2024-to-January-2025) results in a month for our weekend runs, leading to a faster discharge for new mothers/infants. Conclusion The implementation of our L&D syphilis test has successfully streamlined workflow to promptly screen mothers/infants for syphilis. With this change, we are able to adapt to the increased amount of testing brought on by the new ACOG practice advisory and enable the efficient discharge of mothers/infants. We have observed that some clinicians from L&D still order the conventional-syphilis-test, which delays results, and continued clinician education and monitoring are necessary to optimize correct utilization. We hope that other institutions can use this information when implementing workflow changes to adapt to practice guidelines.
Source: Clinical Chemistry
Institutions: University of Virginia, University of Virginia Health System
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4414740868
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