Maternal and Child Health Journal

, Volume 18, Issue 1, pp 16–21 | Cite as

Increased Adherence to Prenatal Group B Streptococcal Screening Guidelines Through a Paired Electronic Reminder and Education Intervention

  • Kathy L. MacLaughlin
  • Gregory M. Garrison
  • Marc R. Matthews
  • Marcia L. O’Brien
  • Elizabeth Westby
  • Paul V. Targonski
Article

Abstract

The 2010 Centers for Disease Control and Prevention (CDC) update on perinatal group B streptococcal (GBS) prevention advises universal vaginal–rectal GBS screening of pregnant women in the 35th through 37th week of gestation. Because GBS colonization is transient, a test performed more than 5 weeks before delivery may not have sufficient negative predictive value to be clinically useful. Our objective was to increase rates of quality-improved, CDC-adherent GBS screening and decrease repeat screening. A reminder for maternal vaginal–rectal GBS testing was added to the physicians’ electronic ordering screen, and family medicine physicians and residents were educated about screening guidelines through standardized, in-person presentations. Retrospective chart review was performed before and after these interventions. Univariate or bivariate analysis was performed for demographic factors, timing of first screen, rates of CDC-adherent screening (the newly defined quality-improved screen and the usual screen), and rates of repeat and unnecessary screens. Multivariate analysis was performed with quality-improved and usual screening as dependent variables. Bivariate analysis showed that post-intervention rates of quality-improved screening increased from 30 to 62 % (P < .001), usual screening increased from 69 to 84 % (P = .005), and repeat GBS screening decreased from 20 to 8 % (P = .007). Multivariate analysis showed increased post-intervention odds of quality-improved screening [odds ratio (OR) 3.59; 95 % CI 2.07–6.34] and usual screening (OR 2.67; 95 % CI 1.40–5.25). Low-cost, reproducible quality improvement interventions (electronic order reminder, educational sessions) have the potential to increase guideline adherence for GBS screening in pregnant women and decrease repeat screening.

Keywords

Group B streptococcal disease Guideline compliance Prenatal screening Quality improvement 

Abbreviations

CDC

Centers for Disease Control and Prevention

GBS

group B streptococcal

ICSI

Institute for Clinical Systems Improvement

V–R

vaginal and rectal

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kathy L. MacLaughlin
    • 1
  • Gregory M. Garrison
    • 1
  • Marc R. Matthews
    • 1
  • Marcia L. O’Brien
    • 1
  • Elizabeth Westby
    • 1
  • Paul V. Targonski
    • 2
  1. 1.Department of Family MedicineMayo ClinicRochesterUSA
  2. 2.Division of Primary Care Internal Medicine, Mayo ClinicRochesterUSA

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