701 - Are Emergency Department Providers Following State and Centers for Disease Control and Prevention Guidelines in Patients Presenting After Sexual Assault?
Thursday, May 14, 2020
Location: Majestic Ballroom: Majestic
Background and Objectives: Sexual violence remains a serious public health problem. The emergency department (ED) is often the initial point of care for sexual assault/abuse victims, thus providers should be knowledgeable in their immediate medical management. This quality assessment project assesses how well providers in our urban ED are following guidelines from the Centers for Disease Control and Prevention and state law and protocols in managing sexual assault/abuse patients.
Methods: We performed a retrospective chart review for all adult patients presenting after sexual assault or abuse in 2018. Patients who were less than eighteen years old, refused consent to an exam, eloped, or presented more than five days after the incident were excluded. We analyzed whether providers followed guidelines on sexually transmitted infection (STI) treatment and post-exposure prophylaxis (PEP), medical forensic exams, pregnancy assessment and prevention, and discharge planning. Proportions for adherence to each guideline and their respective confidence intervals were computed.
Results: 25 charts were identified and reviewed. 100% (95%CI 83.4-100) were offered medical forensic exams and 80% (95%CI 58.7-92.4) were provided discharge planning. 95% (95%CI 73.1-99.7) were tested for pregnancy and 70% (95%CI 45.7-87.2) were offered emergency contraception. 56% (95%CI 35.3-75) were treated for gonorrhea/chlamydia and 48% (95%CI 28.3-68.3) for trichomonas. 88% (95%CI 67.7-96.9) had no gonorrhea/chlamydia testing, 96% (95%CI 77.7-99.8) had no trichomonas testing, and 80% (95%CI 58.7-92.4) had no syphilis testing. 50% (95%CI 27.9-72.2) were tested for HIV and 32% (95%CI 15.7-53.6) were offered PEP. 24% (95%CI 10.2-45.5) were tested for hepatitis B and 12% (95%CI 3.2-32.3) were offered PEP.
Conclusion: While providers were consistent in offering forensic exams and pregnancy tests, there was marked variability in specific STI testing, treatment, and PEP. Given the consequences of sexual violence, emergency providers should recognize deficiencies in their practice to better care for these patients. Standardized treatment guidelines are currently being implemented in this ED as a quality improvement intervention.