| Description |
Background: Syphilis contributes significantly to maternal and infant morbidity and mortality, with infection rates in Utah rising sevenfold from 2012 to 2022. Despite guidelines recommending universal third-trimester syphilis testing, many obstetric clinics only test patients perceived to be at high risk for contracting this disease. Local Problem: By August 2024, less than 20% of pregnant patients within this intervention's healthcare system received third-trimester syphilis testing. Barriers included knowledge gaps among medical assistants (MAs) and registered nurses (RNs), limited training resources for nurse administrators, and time constraints for advanced practice providers (APPs). These barriers contributed to suboptimal testing rates, increasing the risk of missed treatment opportunities and adverse pregnancy and infant outcomes. Methods: This quality improvement (QI) project implemented surveys and interviews with nurse administrators and clinicians (MAs, RNs, and APPs), developed toolkits based on their feedback, and provided education sessions for MAs, RNs, and nurse administrators. Testing rates were assessed through electronic medical record (EMR) reviews before and during the intervention. Stakeholder feedback guided ongoing improvements through the Plan, Do, Study, Act Cycle. Expected outcomes included identifying facilitators and barriers to syphilis screening, improved staff understanding of Triple Testing Guidelines (TTGs), and increased third-trimester syphilis testing rates. Interventions: The project was implemented in multiple phases. Initial surveys and interviews assessed syphilis-testing workflows and informed the development of the first toolkit. Clinicians, nurse administrators, and administrative assistants were educated through in-person and online sessions. Updated toolkits incorporating feedback were distributed. Final surveys measured the intervention's usability, feasibility, and satisfaction. Face-to-face reinforcement and support materials, including toolkits and stickers, emphasized the importance of third-trimester testing. Results: EMR data showed an almost 30% increase in third-trimester syphilis testing rates. Six surveys assessed clinician knowledge and practices, with post-intervention results showing that all responding APPs reported testing their patients 100% of the time. As demonstrated through surveys, understanding of the TTGs among MAs and RNs improved. Conclusion: While objective results were mixed, stakeholder engagement was overwhelmingly positive. Collaboration with the content expert, project sponsor, and nurse administrators facilitated effective implementation across clinics. The distribution of third-trimester syphilis-testing stickers fostered engagement and enthusiasm among clinicians. The addition of syphilis testing to the third-trimester EMR order set offers promise for sustained improvements. The project's combination of toolkits, education sessions, and surveys made it highly adaptable and relevant to future QI initiatives, demonstrating its potential to enhance healthcare quality holistically. |
