Enhancing the Routine Screening Infrastructure to Address a Syphilis Epidemic in Miami-Dade County. (May 2020)

• Record Type: Journal Article
• Authors: Larios Venegas, Alejandro; Melbourne, Heather M.; Castillo, Ileana Aurora; Spell, Kenneth; Duquette, William; Villamizar, Kira; Gallo, Giselle; Parris, Don; Rojas, Lourdes M.
• Is Part Of: Sexually transmitted diseases. Volume 47(2020)Supplement 1 5S
• Publication Date: 2020-05
• Subjects: Sexually transmitted diseases -- Periodicals; Sexual health -- Periodicals; 616.951005
• DOI: 10.1097/OLQ.0000000000001133
• Languages: English
• ISSNs: 0148-5717

Abstract

Abstract : Background: In a recent sexually transmitted disease surveillance report from the Centers for Disease Control and Prevention, Miami-Dade County had the nation's fourth highest rate of infectious syphilis, with rates of congenital syphilis on the rise. As a public health response, Homestead Hospital, in collaboration with the Florida Department of Health, enhanced their emergency department's routine HIV/HCV "opt-out" screening infrastructure to include a syphilis smart screening algorithm. The purpose of this article is to describe the development, implementation, and evaluation of the algorithm. Methods: A retrospective evaluation of patient records prompted the development of the algorithm. Homestead Hospital's electronic health record system automatically triggers a syphilis test based on the reason for medical visit (e.g., rash, penile discharge, a positive pregnancy test, historical or present sexually transmitted disease result). If a patient tests positive, he/she is counseled and linked to care. Results: Since implementation (April 2018 to August 2019), the smart screening algorithm triggered 4806 syphilis tests: 122 patients tested positive (2.5% seropositivity). After confirmatory testing, 59 patients were positive for syphilis, of which 27 were pregnant. Conclusions: The Homestead Hospital and Department of Health–Miami-Dade's response to Miami-Dade County's syphilis problem is innovative and replicable. The program embraces technology, enhances the routine opt-out screening model, and does not affect preexisting workflows. Ultimately, implementation of this algorithm allows patients to get treatment, receive comprehensive prevention services, and, in some cases, avert congenital syphilis. Abstract : A syphilis smart screening algorithm was developed and implemented in the emergency department, which resulted in the identification of patients who were syphilis positive and linked to care.