STD UC screening

[GetMeOuttaThisMess]

Let me start over and rephrase my original post.  For those PA's who are in a free-standing urgent care center, work solo, and provide STI screening, do you obtain your male/female GC/chlamydia screens via GenProbe (swab) or do you utilize UA specimens?  Do you perform any pelvic/speculum exams in this type of setting aside from ext. genitalia exams looking for HSV?  Does the clinic stick to the primary four, i.e.-GC/chlamydia, HSV, and HIV or do you screen for other disease processes as well?

 

How do you perform follow up on such visits once results are returned to the clinic?  Personally?  Nurse calls patient?

 

A position that I'm considering performs STI screening but I've not been made aware as of yet as to the scope of their examinations.  The extent of my last experience with speculum examinations was over ten years ago and performed in the context of seeking vaginal FB's in the ED (physician performed all disease related pelvic examinations at that time in the past).

[Boatswain2PA]

Screening usually consists of urine GC.

 

Symptomatic men = urine GC + rocephin-+ azithro.

 

Symptomatic women depends on symptoms. Might be urine GC + tx, but I wont hesitate to do pelvic (and swabs) for lower and pain to look for PID. That's a "can't ever miss!"

[EMEDPA]

our e.d. group staffs an affiliated U.C. and we do pelvics there and screen for gc, chlamydia, trich, BV, yeast, and herpes. If someone wants screening for HIV, HEP C, syphilis, etc. we send them to the county health clinic. we do both urine GC/C (screening asymptomatic patients) and swabs (symptomatic patients). any c/o vag. d/c gets a pelvic.

if someone looks to have syphilis we will tx and screen but for asymptomatic folks we refer out for testing. results via nurse call or pt call back.

[KMD16]

Agreed. Patient's are notified of test result by phone. The only exception are for HIV. Must come in for result. It's both state and federal law (if my memory serve me well).

[GetMeOuttaThisMess]

Thank you sir.  I appreciate the clinical follow up.  I ended up declining the offer based on two separate stories with regard to how the facility was actually operating (pt. volume primarily), i.e.-left hand and right hand weren't on the same page.  I did find out from the hospital network rep that they don't have a microscope onsite.  When asked about ED transfers which would occur at some point as they always do, she didn't have an answer as to how that would be handled.  Seems the medical group recruiters themselves were more interested in getting a warm body into the slot as opposed to getting the right person into that position.  That, and the fact that the facility has only been open four months and they're already seeking a replacement (don't know the circumstances so who knows, maybe it was just a bad fit to start).  It's hard to explain to someone how one would decline a six figure plus income but it isn't about the money any longer.  During PALS over the last couple of days the instructor commented on how I needed to be in teaching which is what got me into my current situation to begin with (seeking a full-time EMS faculty position this time last year).

[EMEDPA]

re: transfers: Our UC is part of the same system as our e.d. They accept 100% of our transfers, even if they are on divert to everyone else. we probably see 85-105 pts/day and transfer around 10-15, with 2-3 of them by ambulance. We just call like any other inter-facility transfer. the same group staffs both places so they never give us grief from the receiving end because they know the limits of the UC facility in terms of available meds, labs, diagnostic studies, etc.

[Febrifuge]

* do you obtain your male/female GC/chlamydia screens via GenProbe (swab) or do you utilize UA specimens?  

 

- Either/ both, depending. If male, and patient declines the swab (which happens about 100% of the time), we can run the urine test. If female, 95% of the time I'm also doing a wet prep, so the swab is better.

 

* Do you perform any pelvic/speculum exams in this type of setting aside from ext. genitalia exams looking for HSV?  

 

- Yes, all the time. nonspecific complaints like discharge or odor get a more general exam and workup, usually a wet prep ( + or - a urine first), with the GC/ Chlamydia swab being frequently a part of that.

 

* Does the clinic stick to the primary four, i.e.-GC/chlamydia, HSV, and HIV or do you screen for other disease processes as well?

 

Pretty much these. Our labs take days to turn around, with the exception of the wet prep which is 10 minutes, so it's blood for HIV or syphillis. I only do HSV tesing if I have something to swab, and most of the people who come to me worried about herpes don't actually have lesions, or else they know what they are because they have been previously diagnosed.

 

* How do you perform follow up on such visits once results are returned to the clinic?  Personally?  Nurse calls patient?

 

- I work in a big care system, and there's a team of RNs who watch the Epic in-box for new test results. Anything I would be ordering would generate a phone call from them, if the result is abnormal/ positive. Otherwise, patients get an email or a letter.

[GetMeOuttaThisMess]

Thanks for the additional input folks.  With regard to ED transports, the hospital is diagonal across a major intersection from the UC clinic.  When I inquired as to whether or not they kept, or anticipated keeping, a unit at the hospital for said transports neither party (med staffing group or the hospital mgmt) had an answer. I would have hated to have to call local fire/rescue (one stationed about a 1/4 mi. down one of the two major throughfares) for such if it could be avoided.  I just found it interesting that this major, well-known, EM staffing group, as well as a major healthcare entity wouldn't have thought about some of these circumstances beforehand.  With regard to the STI follow up, the staffing apparently would be the PA as well as two MA's (one with cross radiologic training and the other with front desk skills).  If the volume was as described by the hospital mgmt. rep, I'm not sure where the MA's would find the time to do pt. follow up (and being a type A, I'm not sure that I could have delegated same without knowing that it was handled appropriately).

 

The reason why the pelvic question came up was because the website states STI evaluations but says nothing with regard to other gynecologic care.  My former employer had an STI clinic overseen by an NP and she would do pelvic assessments but would also perform well woman exams at the same time.  Since the GC/chlamydia could be handled via a UA (I'm sadistic enough to where with the males it was always the GenProbe), the syphilis/HIV from phlebotomy, and the HSV assessment from external exam I wasn't sure what their policy was.  If anything like above, I'm not sure that they would have known.  With regard to email or letter follow up, you wouldn't believe how my former SP ran the NP crazy with legal backside covering (i.e.-"covering their arse") on these matters.  Multiple registered letters, phone calls, etc. and even then it wouldn't be enough.  Oh well, it's all water under the bridge at this point in time.