Nurse and Physician Stakeholder Guidance on Improving Sexually Transmitted Infection Care in a Pediatric Emergency Department.
- 1University of South Florida, Morsani College of Medicine, Department of Emergency Medicine, Tampa, Florida.
- 2Icahn School of Medicine at Mount Sinai, Department of Emergency Medicine, New York City, New York.
- 3Brown University School of Public Health, Department of Health Services, Policy and Practice, Providence, Rhode Island.
Abstract
Introduction
Pediatric emergency departments (PEDs) and general EDs in the United States (U.S.) do not consistently deliver sexually transmitted infection (STI) care that aligns with clinical guidelines. To inform the development of an implementation strategy plan aimed to improve STI care in a PED, we interviewed PED nurse and physician stakeholders to identify challenges and corresponding potential solutions aimed to improve STI care in a PED.Methods
We conducted semi-structured interviews with 27 stakeholders consisting of emergency medicine (EM) residents, pediatrics residents, pediatric EM (PEM) fellows, attending pediatric emergency physicians, and PED nurses at an academic urban PED. Using the Tailored Implementation in Chronic Diseases (TICD) framework, we prepared semi-structured interview guides specific to stakeholder roles structured according to the usual six successive workflow stages of STI care in the PED (triage, history-taking, physical examination, testing, treatment, and follow-up). Questions concerned current practices on providing STI care, challenges encountered, and potential solutions. Interviews were transcribed and analyzed using rapid content analysis. Responses were coded independently by two reviewers and categorized by TICD determinant domain.Results
Participants identified multilevel implementation challenges across the stages of STI care in the PED. Structural challenges included lack of privacy and limited private exam rooms, inadequate STI-related workflows, and inadequate waiting areas. Procedural challenges included the following: nonstandardized triage protocols; unclear role delineation; confusing sample collection procedures; insufficient training in STI examination, testing, and treatment procedures; variable documentation practices; and difficulty ensuring follow-up. Suggested solutions included development of role-specific STI protocols, smart phrases for documentation, improved sample-labeling procedures, prepackaged medications for empiric treatment, and embedded referral pathways to an adolescent care clinic.Conclusion
Using the TICD framework, this study identified key challenges, such as gaps in training, protocols and transition of care, and corresponding stakeholder-informed solutions to improve adolescent care for STIs in a pediatric ED setting. These findings can guide efforts to implement evidence-based STI practice guidelines in PEDs and general EDs.
Related
- Resurgence of Sexually Transmitted Hepatitis C Virus Infection in Men Who Have Sex With Men Living With HIV
- Sexually transmitted infection testing among U.S. adolescents in relation to U.S. Preventive Services Task Force screening guidelines
- Impact of Secure Electronic Health Record Chat on Physician Communication in the Emergency Department.
- A Transfusion-transmitted Chronic Hepatitis E Virus Infection after Allogeneic Bone Marrow Transplantation with Viral Clearance Following Immunosuppression Tapering
- Clinician stakeholder priorities for improving the management of non-traumatic wrist disorders in the UK: a nominal group technique study
BibTeX
@article{merchant2026nurse,
title = {{Nurse and Physician Stakeholder Guidance on Improving Sexually Transmitted Infection Care in a Pediatric Emergency Department.}},
author = {Roland C Merchant and Daniela Ramirez-Castillo and Arlet Capeta Romero and Rachel Solnick and Patricia Mae Martinez and Christopher Strother and Melissa A Clark},
journal = {The western journal of emergency medicine},
year = {2026},
month = sep,
doi = {10.5811/westjem.61866},
url = {https://europepmc.org/article/MED/42900921},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nurse and Physician Stakeholder Guidance on Improving Sexually Transmitted Infection Care in a Pediatric Emergency Department.
AU - Roland C Merchant
AU - Daniela Ramirez-Castillo
AU - Arlet Capeta Romero
AU - Rachel Solnick
AU - Patricia Mae Martinez
AU - Christopher Strother
AU - Melissa A Clark
PY - 2026
DA - 2026/09/09
JO - The western journal of emergency medicine
DO - 10.5811/westjem.61866
UR - https://europepmc.org/article/MED/42900921
AB - Introduction Pediatric emergency departments (PEDs) and general EDs in the United States (U.S.) do not consistently deliver sexually transmitted infection (STI) care that aligns with clinical guidelines. To inform the development of an implementation strategy plan aimed to improve STI care in a PED, we interviewed PED nurse and physician stakeholders to identify challenges and corresponding potential solutions aimed to improve STI care in a PED.Methods We conducted semi-structured interviews with 27 stakeholders consisting of emergency medicine (EM) residents, pediatrics residents, pediatric EM (PEM) fellows, attending pediatric emergency physicians, and PED nurses at an academic urban PED. Using the Tailored Implementation in Chronic Diseases (TICD) framework, we prepared semi-structured interview guides specific to stakeholder roles structured according to the usual six successive workflow stages of STI care in the PED (triage, history-taking, physical examination, testing, treatment, and follow-up). Questions concerned current practices on providing STI care, challenges encountered, and potential solutions. Interviews were transcribed and analyzed using rapid content analysis. Responses were coded independently by two reviewers and categorized by TICD determinant domain.Results Participants identified multilevel implementation challenges across the stages of STI care in the PED. Structural challenges included lack of privacy and limited private exam rooms, inadequate STI-related workflows, and inadequate waiting areas. Procedural challenges included the following: nonstandardized triage protocols; unclear role delineation; confusing sample collection procedures; insufficient training in STI examination, testing, and treatment procedures; variable documentation practices; and difficulty ensuring follow-up. Suggested solutions included development of role-specific STI protocols, smart phrases for documentation, improved sample-labeling procedures, prepackaged medications for empiric treatment, and embedded referral pathways to an adolescent care clinic.Conclusion Using the TICD framework, this study identified key challenges, such as gaps in training, protocols and transition of care, and corresponding stakeholder-informed solutions to improve adolescent care for STIs in a pediatric ED setting. These findings can guide efforts to implement evidence-based STI practice guidelines in PEDs and general EDs.
SN - 1936-900X
SN - 1936-9018
ER -