Nurse-Led Quality Improvement Project via a Standardized STI Screening and Testing Protocol in Ambulatory Care HIV/STD Clinic during COVID-19 Pandemic

Background: According to the CDC, a sharp increase in sexually transmitted infection (STI) rates resulted in the highest documented rates in six years (2019). This includes an increase of 42% in gonorrhea, 61% in chlamydia, and 50% in syphilis. Men who have sex with men (MSM) represented 55% of all STI cases (CDC, 2021). Researchers fear an upsurge in STI rates may be due to an increasing obstruction of routine preventative care. While the CDC’s data was captured prior to the COVID-19 pandemic, the global pandemic may be a barrier to regular STI testing in MSM. The purpose of this nurse-led quality improvement project was to improve rates of STI testing with accelerated treatment in MSM during the COVID-19 pandemic.

Methods: A nurse-led, quality improvement project was implemented using a PDSA framework. In phase one, an interdisciplinary group (physician, advanced practice provider, nursing) met to develop a plan to optimize expeditious access to STI screening, testing, and treatment. In phase two, the nurse-led interdisciplinary group developed an STI screening tool and education was provided to the clinical team on utilization. STI protocols were standardized and included a COVID-19 screening. In the protocol, positive STI and COVID-19 screens are identified by the nurse, followed by nurse-led order entry of standing STI and site-specific labs including oral, rectal, and urine specimens. The standardized protocol allows the nurse to conduct in-person, STI testing in the clinic setting, and allows expeditious test results prior to a virtual provider visit. For positive tests, treatment is initiated the day of the virtual visit with the provider. In phase three and four, the nurse will perform audits to collect quality data to enhance the protocol, with targeted interventions to address practice gaps.

Results: From October 2020 to April 2021, 559 patients completed the nurse-led STI screening questionnaires and 249 patients received site-specific STI testing. The positive STI rate was 14.8% with time to initiation of STI treatment reduced to less than one day.

Baseline STI testing rates in 2018 to 2019 were 9.7%. Following implementation of the nurse-led protocol, the testing rate increased to 17.4%.

Discussion: Using a PDSA framework, implementation of a nurse-led STI screening and testing protocol demonstrated improved patient outcomes. Despite COVID-19 being an added barrier to STI testing, STI testing rates increased during this time period using a nurse-led STI protocol. As the protocol continues with further PDSA cycles, we anticipate further enhancements with increased testing rates.