Impact of a Computerized Order Set on Adherence to Centers for Disease Control Guidelines for the Treatment of Victims of Sexual Assault

Abstract

BackgroundCare of the sexual assault patient in the Emergency Department can be challenging due to complex pharmacologic interventions, evidence-collection procedures, and concomitant injury. ObjectiveWe sought to determine the effect of a standard, computerized order set for the treatment of adult victims of sexual assault on compliance with current Centers for Disease Control and Prevention (CDC) guidelines for the treatment of this population. MethodsThis study utilized a pretest–post-test design to evaluate the implementation of a standardized order set that provided clinicians with treatment recommendations consistent with CDC guidelines. Comparison of the rate of compliance with CDC guidelines before (n = 322) and after (n = 131) implementation of the order set was the primary outcome. Additional analyses examined for differences in compliance based upon evaluation by a sexual assault nurse/forensic examiner (SANE/SAFE), sex, and race. ResultsPre-intervention phase compliance was 14 of 322 cases (4.4%) and post-intervention compliance was 108 of 131 cases (82.4%). This difference was statistically significant, χ2 = 291.635, df = 1, p < 0.001. Overall, compliance with CDC pharmacologic recommendations was achieved in 122 (26.9%) cases. Evaluation by a SANE/SAFE nurse conferred no statistically significant difference in compliance. No statistically significant differences were noted based upon sex or race. ConclusionsThe implementation of a standard, computerized order set for the treatment of adult victims of sexual assault significantly improved medical provider compliance with CDC treatment guidelines. This research demonstrates that electronic order sets can promulgate evidence-based practices in clinical medicine.