Clinical audit of the process of referral to genitourinary medicine of patients found to be chlamydia positive in a family planning service

Abstract

This paper describes a collaborative audit between a large family planning and genitourinary medicine (GUM) service undertaken to ensure that all women presenting for termination of pregnancy (TOP) or IUD fitting were offered screening for chlamydia, were informed of a positive result, and were subsequently referred to GUM for full sexual health screening and contact tracing. Over a six month period in 1996 1072 patients were seen for either TOP (763) or W1) fitting (309) and of these 999 were offered a test which was performed in 988. Overall 38 positive tests were reported (3.8 per cent) but only two of 259 patients tested prior to lUD fitting were found to have chlamydia (<0.8 per cent). Only 27 of these 38 women (74 per cent) had information recorded in their notes that they had been given their result and 24 patients (63 per cent) were seen in GUM. The audit uncovered problems with documentation and cross-referencing of information which largely accounted for the failure to reach some of the standards set. An action plan has been formulated in an attempt to improve this aspect of the screening service. If more widespread screening for chlamydia is to be effectively implemented as recommended by the 31st RCOG Study Group on the Prevention of Pelvic Infection, then it is of importance that workable local protocols are in place including arrangements for partner notification and treatment. This will involve close collaboration between a range of specialities working in the sexual health field.

PIP: A full chlamydia screening program was implemented in Portsmouth, UK, in 1993 for all women attending the family planning service for induced abortion, IUD insertion, or with suspicious clinical symptoms. An audit was conducted over a 6-month period in 1996 to ensure that family planning clients were being offered screening for chlamydia, informed of a positive test result, and, if positive, referred to the genitourinary medicine department for a full sexual health screening and contact tracing. 999 patients (93.2%) who attended the clinic during the study period for induced abortion or IUD fitting were offered chlamydia testing. 38 of these women (3.8%) were chlamydia-positive. Referrals were made to the genitourinary medicine department for 28 of these women (74%). Overall, 24 women (63%) with a positive chlamydia test presented to the genitourinary medicine clinic, a mean time of 10 working days after testing. 15 of these women identified contacts. The audit revealed major deficiencies in accurate, reliable documentation. An action plan has been formulated to improve this aspect of the screening service.