Electronic Messaging for Gonorrhea and Chlamydia Test Result Notification, Improving Treatment and Patient Satisfaction.

BACKGROUND: Approximately 20% of chlamydia (CT) and gonorrhea (GC) cases in Louisiana are diagnosed at Parish Health Units. Patient notification of CT and GC test results involves nurses' phone calls and letters to positive patients, which is time-consuming and inefficient. METHODS: In December 2018, electronic results notification was implemented in Caddo Parish Health Unit using Chexout software to notify enrolled patients via text or email when test results are ready to view in a patient portal. We compared the timeliness of GC/CT results notification and treatment pre-Chexout (December 2017 to November 2018) and post-Chexout (December 2018 to November 2019) implementation. A random sample of patients was interviewed to assess acceptability. RESULTS: During December 2018 to November 2019, 5432 patients were tested for CT/GC, 3924 (72%) enrolled in Chexout, and notifications were sent to 3884 (99%). Among CT-positives, 472 of 568 (83%) viewed results in the portal compared with 2451 of 3356 (73%) CT-negatives. Among GC-positives, 300 of 353 (85%) viewed results compared with 2657 of 3571 (74%) GC-negatives. Treatment success for CT improved from 493 of 670 (74%) to 506 of 568 (89%), and for GC, from 332 of 409 (81%) to 325 of 353 (92%). Mean time to treatment decreased for CT (13.4-10.7 days) and GC (11.3-9.2 days). Enrolled patients found Chexout notification satisfactory in 168 of 169 (99%) and easy to use in 130 of 141 (92%). Reasons for declining electronic notification included lack of personal cell phone for 55 of 86 (64%) and confidentiality concerns for 42 of 86 (49%). CONCLUSIONS: Electronic messaging decreased time to notification and increased treatment success. Nurses spent less time notifying patients leaving more time for patient care.

Preanesthesia screening phone messages and rate of return based on the primary language of patient.

As a part of the surgical process, patients are screened in the preanesthesia services department before surgery. Often phone messages are left in English. The nurses will continue to make multiple calls trying to reach patients. As the patient population continues to diversify, problems in contacting patients have been noted. It was suspected that patients whose primary language was non-English were returning phone messages at a lower rate than patients whose primary language was English. The project was conducted over a 6-week period and a total of 1,438 documented cases were reviewed and included. A Chi-square analysis was performed on the data. Compared with English-speaking patients, non-English-speaking patients required almost twice as many calls on average to make contact. In addition, non-English-speaking patients were less likely to return telephone calls than were the English-speaking patients (P<.001). Furthermore, the percentage of day of service interviews was higher for non-English-speaking patients compared with English-speaking patients (P<.01). Based on these findings, processes for identifying the linguistic needs of our patients have been changed in an effort to provide safer quality care.

Self-collected versus provider-collected vaginal swabs for the diagnosis of bacterial vaginosis: an assessment of validity and reliability.

Bacterial vaginosis (BV) in pregnancy is related to numerous adverse events; however, the validity of different methods of vaginal swab collection to diagnosis BV among pregnant women is unclear. This study examines the validity of self-collected compared with provider-collected vaginal swabs and describes the intra-rater and inter-rater reliability of BV assessment among a sample of pregnant women early in gestation. Gram-stain evaluation of vaginal samples using the Nugent criteria was conducted to determine the overall and morphotype-specific BV scores. We found strong validity for the overall and morphotype-specific scores comparing self-collected swabs to provider-collected swabs. In addition, we found excellent overall and morphotype-specific inter-rater reliability and excellent intra-rater reliability in our sample. These study results support the use of self-collected vaginal swabs for diagnosing BV and document the reliability of BV assessment among pregnant women.

A PACU crisis: a case study on the development and management of methemoglobinemia.

The development of methemoglobinemia requires rapid recognition, confirmation, and treatment. This case study describes the development, diagnosis, and management of a 63-year-old male scheduled for a laparoscopic cholecystectomy with an intraoperative cholangiogram who developed methemoglobinemia after benzocaine was given for intubation.