SHM Converge Scientific Abstract ePoster Gallery-Increasing Syphilis Screening Among Patients at an Urban Safety-Net Hospital

Pdf Summary

This quality improvement project aimed to increase syphilis screening among at-risk patients admitted to internal medicine resident services at Zuckerberg San Francisco General Hospital, an urban safety-net hospital. Rising syphilis and congenital syphilis rates nationally and in San Francisco motivated the work. At-risk patients were defined using SFDPH guidance as those with childbearing potential (female sex under age 50), homelessness, HIV and/or HCV infection, or active methamphetamine use.<br /><br />The project used incentive-based A3 methodology and implemented several interventions over time: education, publicity, and monthly feedback starting in July 2022; electronic medical record (EMR) tools to track prior syphilis testing in November 2022; and an opt-in syphilis test added to the admission order set in January 2023.<br /><br />The primary outcome was the proportion of at-risk patients with syphilis screening within one year of admission. Screening increased from 48.3% in the baseline period to 58.3% during the intervention period, a relative increase of 20.7%. The hospital saw 2,140 unique patients (2,609 admissions) in the baseline period and 2,638 unique patients (3,204 admissions) in the intervention period; at-risk patients made up about 40% to 45% of admissions.<br /><br />Resident surveys identified common barriers to screening: lack of awareness of guidelines, competing clinical priorities, uncertainty about which syphilis test to order, and patient acuity.<br /><br />The authors concluded that hospitalization is an important opportunity to perform guideline-recommended syphilis screening and that combining education, feedback, and EMR-based changes can meaningfully improve screening rates. They noted limitations including poor EMR quality for sexual orientation and gender identity, inability to capture outside testing, and no assessment of whether more screening led to more diagnoses. Future plans include changing the order set to opt-out and improving follow-up for newly diagnosed patients.

Asset Subtitle

April S. Liang

Meta Tag

Author List April S. Liang, Nicole Dalal, Rebeccah M. Brusca, Stephanie Cohen

Category Research

Concept Syphilis Screening Test

Concept At-Risk Patient

Concept Quality Improvement

Concept Rising Incidence

Concept Guideline

Distinguished Non-Finalist

Presenter Organization Stanford University School of Medicine

Presenting Author April S. Liang

Track Quality Improvement

Keywords

syphilis screening

quality improvement

internal medicine

safety-net hospital

at-risk patients

electronic medical record

resident education

admission order set

congenital syphilis

A3 methodology

Syphilis Screening Test

At-Risk Patient

Quality Improvement

Rising Incidence

Guideline