1904. Implementation of a Nursing Triage Order to Improve Utilization of Rapid Diagnostic Testing for Chlamydia and Gonorrhea in the Emergency Department
Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Taylor_IDWeek_Poster_Draft6_Final.pdf (601.3 kB)
  • 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 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.

    Taylor Sikkenga, PharmD1, Lisa Dumkow, PharmD, BCPS2, Heather Draper, PharmD, BCPS2, Kasey Brandt, PharmD, BCPS2, Kaitlyn Rivard, PharmD3, Katie Axford, PharmD, BCPS1, David Whalen, MD, MPH, FACEP4 and Nnaemeka Egwuatu, MD, MPH5, (1)College of Pharmacy, Ferris State University, Big Rapids, MI, (2)Department of Pharmacy Services, Mercy Health Saint Mary's, Grand Rapids, MI, (3)Pharmacy, Cleveland Clinic, Cleveland, OH, (4)Emergency Medicine, Mercy Health Saint Mary's, Grand Rapids, MI, (5)Infectious Diseases, Mercy Health Saint Mary's, Grand Rapids, MI

    Disclosures:

    T. Sikkenga, None

    L. Dumkow, None

    H. Draper, None

    K. Brandt, None

    K. Rivard, None

    K. Axford, None

    D. Whalen, None

    N. Egwuatu, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.