Impact of Post-visit Contact on Emergency Department Utilization for Adolescent Women with a Sexually Transmitted Infection

Abstract

Study ObjectivesTo understand Emergency Department (ED) utilization patterns for women who received sexually transmitted infection (STI) testing and explore the impact of post-visit telephone contact on future ED visits. Design, Setting, ParticipantsWe performed a secondary analysis on a prospectively collected dataset of ED patients ages 14-21 years at a children's hospital. Interventions and Main Outcome MeasuresThe dataset documented initial and return visits, STI results, race, age and post-visit contact success (telephone contact ≤7 days of visit). Logistic regression was performed identifying variables that predicted a return visit to the ED, a return visit with STI testing, and subsequent positive STI results. ResultsOf 922 women with STI testing at their initial ED visit, 216 (23%) were STI positive. One-third (315/922) returned to the ED, 15% (141/922) returned and had STI testing, and 4% (38/922) had a subsequent STI. Of 216 STI-positive women, 59% were successfully contacted. Of those who returned to the ED, age ≥ 18 and Black race were associated with increased STI testing at a subsequent visit. Successful contact reduced the likelihood of STI testing at a subsequent ED visit (OR 0.28, 95% CI 0.01-0.8), and ED empiric antibiotic treatment had no effect on subsequent STI testing. ConclusionContacting women with STI results and counseling them regarding safe sex behaviors may reduce the number of ED patients who return with symptoms or a new exposure necessitating STI testing. The high STI prevalence and frequent return rate suggest that ED interventions are needed.