Little is known about gaps in quality and the extent to which clinical standards are used in emergency department (ED) practice.
Objectives: To determine whether ED practitioners comply with the Centers for Disease Control and Prevention (CDC) recommendations for diagnosing and treating sexually transmitted diseases (STDs).
Methods: A retrospective chart review of ED visits was conducted at an urban teaching hospital. Using ICD-9 codes, urethritis, cervicitis, pelvic inflammatory disease (PID), gonorrhea, and chlamydia cases seen from May 1, 2000, to February 28, 2001, were identified. Documentation of components of the history, physical examination, diagnostic testing, prescribed antibiotics, and discharge instructions necessary to comply with the CDC guidelines were abstracted. This set of comprehensive criteria was compared with a less stringent subset of selected criteria.
Results: Two hundred forty-six patient visits were identified, and 203 (83%) were included. Forty-eight men and 155 women were included: 48 (24%) with urethritis, 34 (17%) with cervicitis, and 121 (60%) with PID. For urethritis, cervicitis, and PID, respectively, there was documentation of compliance with indicators related to the following: history 73%, 15%, and 14%; physical examinations 63%, 15%, and 22%; diagnostic testing 79%, 71%, and 71%; antibiotic use 33%, 32%, and 32%; and safe sex instructions 50%, 18%, and 15% of the time. Men were more likely to receive safe sex instructions (p < or = 0.01). Total (100%) compliance in all five domains occurred 8% of the time for urethritis, 3% for cervicitis, and never for PID. The rates of 100% compliance were not significantly different when a subset of selected criteria was used.
Conclusions: Deficits in adherence to recommended guidelines for the diagnosis and treatment of STDs exist in ED practice.