(618) Does a best practice implementation prompting providers on syphilis screening guidelines impact physician adherence?

According to the 2021 Centers for Disease Control and Prevention Sexually Transmitted Disease Surveillance report, the number of congenital syphilis (CS) cases increased 754.8% from 2012 to 2021. Missed opportunities for CS prevention in Texas include a lack of provider adherence to screening mandates. A best practice advisory (BPA) was implemented in the electronic medical record system (EMR) in an academic obstetrical center in Texas in April 2023 to prompt providers to screen pregnant patients at initiation of prenatal care, 28 weeks gestation, and admission for delivery. This quality initiative aimed to determine if provider adherence to the screening mandate improved with the BPA.

Study Design:

This was a prospective cohort study of obstetric patients from a large public healthcare system in Southeastern Texas between 12/01/22 and 05/31/23.  Individuals who initiated care after 26 weeks gestation were excluded. Data regarding gestational age at each screen and corresponding results were collected prior to and after implementation of the BPA. The number of appropriately ordered syphilis screening tests pre- and post-BPA were compared using chi-square analysis with a p-value < 0.05 considered statistically significant.

Results:

Screening for syphilis at initiation of care did not increase with the BPA, however screening rates at admission for delivery increased significantly from 6% to 99% post-BPA (p < 0.05). Screening at both 28 weeks and delivery also increased significantly from 3% to 89% (p < 0.05), and screening at all three timepoints (initiation, 28 weeks, delivery) significantly increased from 2% to 47% (p < 0.05) [Table 1, Figure 1]. Notably, there was a 50% reduction in CS cases (8 to 4) following the BPA.

Conclusion:

The use of a BPA within the EMR increased provider adherence to syphilis screening mandates for pregnant women in a high CS morbidity region. Given the differing screening mandates across the US, utilization of a BPA to inform providers about state-specific mandates can lead to improved compliance with perinatal syphilis screening and help prevent congenital syphilis.