Work

Implementation of a Nursing Triage Order to Improve Utilization of Rapid Diagnostic Testing for Chlamydia and Gonorrhea in the Emergency Department

Year: 2016

Type: article

Abstract: Background. The implementation of rapid diagnostic testing (RDT) has proven beneficial to antimicrobial stewardship programs. The use of RDT can only be optimized when ordered in a timely fashion and when results are acted upon quickly. The purpose of this study was to determine the impact of implementing a nursing triage order to initiate Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) RDT in an urbran emergency department (ED). We hypothesized that the implementation of the triage order would decrease the time to results and increase the proportion of patients notified of results prior to discharge. Methods. A three-arm, retrospective, quasi-experimental study was conducted of patients ≥15 years of age who received screening for CT/NG in the ED: Traditional versus RDT versus Triage RDT screening. Patients screened at a satellite location, requiring inpatient admission, or diagnosed with pelvic inflammatory disease were excluded. Data collected included patient and screening characteristics, antimicrobial therapy, and clinical outcomes. Groups were compared based on whether results were available prior to discharge and receipt of appropriate antimicrobial treatment. Results. A total of 555 patients were included: 200 each in the Traditional and RDT groups and 155 in the Triage RDT group. Demographics were similar between groups. Nurses ordered 52.3% of tests in the Triage RDT group and more patients had CT/NG testing ordered within 30 minutes of ED arrival (Traditional 31% versus RDT 27.5% versus Triage RDT 54.8%, p < 0.001). Results were more likely to be available within 2 hours of ED arrival (Traditional 0% versus RDT 56.5% versus Triage RDT 72.3%, p < 0.001) and prior to discharge (Traditional 0% versus RDT 20% vs. Triage RDT 31%, p = 0.018). Treatment was more likely to be appropriate with use of RDT (Traditional 60% versus RDT 72.5% versus Triage RDT 73.5%). Median time to notification of positive result was decreased in the RDT groups (Traditional 53.7 hours [26.9–79.9] versus RDT 17.4 hours [0–93] versus Triage RDT 22.7 hours [0–101.9], p = 0.009). There was no difference in ED length of stay between groups. Conclusion. Implementation of an ED triage nursing order for CT/NG RDT was associated with a significant increase in the proportion of patients with results available prior to discharge. These results support the incorporation of nursing into stewardship programs to promote optimal use of RDT. Disclosures. All authors: No reported disclosures

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1452