title: Improving the assessment and treatment of pelvic inflammatory disease among adolescents in an urban children's hospital emergency department.
abstract: BACKGROUND
  Proper pelvic inflammatory disease (PID) assessment and treatment is essential in preventing ectopic pregnancies, repeated PID infections, infertility, chronic pelvic pain, and fetal death. This project measured the effectiveness of interventions directed toward the providers in the emergency department to facilitate a change in the assessment and treatment of PID. Two aims identified for the project included increasing the number of providers who recorded a correct diagnosis of PID in the chart and included a sexual history for female adolescents who presented to the emergency department with abdominal pain. An additional aim was to increase the percentage of adolescents who received the correct treatment for PID.
  
  
  METHODS
  A quality improvement study using pre-post design and Plan-Do-Study-Act cycles over an 18-month period was conducted in the emergency department of an urban children's hospital. Assessment of adolescent female patients' history of recent sexual activity and correct diagnosis and treatment of PID were evaluated. Process improvement interventions consisted of PowerPoint presentations, educational materials, and Centers for Disease Control and Prevention (CDC) treatment guidelines posted in provider areas (Table 1), along with ongoing positive and corrective feedback to providers.
  
  
  RESULTS
  A total of 602 patient records were reviewed (119 in the PID diagnosis and treatment arm and 483 in the obtaining sexual history arm). After process improvement interventions, correct PID diagnosis increased from 72% to 95% (z = 3.064, P = .00109, odds ratio [OR] = 7.08). Correct PID treatment increased from 39.3% to 79.3% (z = 4.190, P = .0000139, OR = 5.90). The percentage of providers who obtained a sexual history increased from 65% to 74.2% (z = 1.892, P = .02929, OR = 1.55).
  
  
  CONCLUSIONS
  The study demonstrated a significant improvement in all 3 aims related to improved care of adolescents with PID. PowerPoint presentations and the physical presence of the CDC treatment guidelines in the provider treatment areas were instrumental for success. Nurses play a pivotal role in the implementation and success of quality improvement projects for improving patient outcomes.
authors.affiliation: Denver, CO. Electronic address: cmccallu@regis.edu.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: McCallum
authors.affiliation: Denver, CO.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Oman
authors.affiliation: Denver, CO.
authors.forename: Mary Beth Flynn
authors.initials: MB
authors.lastname: Makic
mesh_terms: D000293:Adolescent; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006776:Hospitals, Pediatric; D006786:Hospitals, Urban; D006801:Humans; D009730:Nursing Assessment; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D016730:Program Development; D015397:Program Evaluation; D058996:Quality Improvement; D012725:Sexual Behavior; D014505:Urban Population
keywords: Adolescents; Emergency department; Pelvic inflammatory disease; Provider barriers; Treatment guidelines