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 vs. RDT vs. 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: 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% vs. RDT 27.5% vs. Triage RDT 54.8%, p<0.001). Results were more likely to be available within 2 hours of ED arrival (Traditional 0% vs. RDT 56.5% vs. Triage RDT 72.3%, p<0.001) and prior to discharge (Traditional 0% vs, RDT 20% vs, Triage RDT 31%, p=0.018). Treatment was more likely to be appropriate with use of RDT (Traditional 60% vs. RDT 72.5% vs. Triage RDT 73.5%). Median time to notification of positive result was decreased in the RDT groups (Traditional 53.7 h [26.9-79.9] vs. RDT 17.4 h [0-93] vs. Triage RDT 22.7 h [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.
H. Draper, None
K. Brandt, None
K. Rivard, None
K. Axford, None
D. Whalen, None
N. Egwuatu, None