SHM Converge Scientific Abstract ePoster Gallery-Improving Syphilis Screening Among Patients Admitted to an Urban Safety-Net Hospital Through Iterative Quality Improvement Efforts

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This quality improvement project examined syphilis screening among patients admitted to the Internal Medicine service at an urban safety-net hospital in San Francisco, where syphilis rates are among the highest in the U.S. The team used iterative A3 methodology and multiple PDSA cycles to improve screening for “at-risk” patients based on local public health guidelines. Risk factors included female sex under age 50, homelessness, HIV, active stimulant use, MSM/trans people who have sex with men, and abnormal STI testing in the prior year.<br /><br />Interventions progressed over time: education and feedback, then an opt-in syphilis test added to the admission order set, followed by an opt-out test added to the order set in February 2024. The study included 6,764 unique admissions.<br /><br />Results showed a major improvement after the opt-out intervention. Syphilis screening among at-risk patients increased from 21.6% before implementation to 68.8% afterward. The largest gain was among people of childbearing potential, whose screening rate rose from 19.8% to 86.1%. In regression analysis, the opt-out intervention was associated with higher screening overall (OR 3.7, p<0.0001), and the interaction effect for people of childbearing potential was even stronger (OR 6.0, p<0.0001). The rate of abnormal screening tests per 100 at-risk admissions also increased after opt-out testing.<br /><br />The authors conclude that inpatient admission is a useful opportunity to perform guideline-based syphilis screening, and that opt-out testing can substantially improve screening, especially for people of childbearing potential. Limitations include reliance on EMR-documented risk factors, which may miss some patients, and the inability to confirm whether abnormal tests represented new infections or whether treatment improved. Future work will link results with public health data and assess treatment follow-up.

Asset Subtitle

Maxwell Birger

Meta Tag

Author List Maxwell Birger, Rebeccah M. Brusca, Seth Goldman, Stephanie Cohen, Trang Nguyen

Category Research

Concept Syphilis Screening Test

Concept At-Risk Patient

Concept Opt-Out Screening

Concept Quality Improvement

Concept PDSA Cycle

Distinguished Non-Finalist

Presenter Organization UCSF at Zuckerberg San Francisco General, Division of Hospital Medicine

Presenting Author Maxwell Birger

Track Quality Improvement

Keywords

syphilis screening

quality improvement

opt-out testing

inpatient admission

Internal Medicine

safety-net hospital

PDSA cycles

A3 methodology

public health guidelines

at-risk patients

Syphilis Screening Test

At-Risk Patient

Opt-Out Screening

Quality Improvement

PDSA Cycle