Implementation of a Best Practice Alert (BPA) for Syphilis Testing During Pregnancy to Reduce Congenital Syphilis [ID 737]

INTRODUCTION: In 2022, Texas reported the highest case count of congenital syphilis (CS), with Houston reporting record high rates. In December 2022, a Best Practice Advisory (BPA) was embedded into the electronic medical record (EMR) at a large safety-net obstetrics center in Houston to improve provider adherence to the Texas State Mandate 81-090. The goal of this quality improvement initiative is to determine whether the implementation of this BPA reduced CS rates. METHODS: This was a prospective study of all pregnant patients who sought care and delivered at a large safety-net system in Houston, Texas, between 2021 and 2023. Compliance to the BPA was verified, and rates of CS at the delivery site before and after implementation of the BPA were calculated. Chi-squared was used for statistical analysis, and a value of P <.05 was considered significant. RESULTS: Prior to implementation of the BPA, there were 22 CS cases among 8,697 deliveries (0.25%), and after implementation, 5 CS cases among 5,367 (0.09%) deliveries were reported ( P =.04). This negatively correlated with rates of CS in Houston, which increased from 23.6/10,000 in 2021 to 24.8/10,000 in 2022 and 11.1/10,000 in 2023 ( P =.05). Compliance to the BPA was 89% for all time points and 99% at delivery. CONCLUSIONS/IMPLICATIONS: The implementation of a BPA within the EMR significantly enhanced provider adherence to syphilis screening guidelines and reduced CS in a high-prevalence region. Leveraging a BPA to disseminate state-specific screening mandates can substantially improve compliance with perinatal syphilis screening protocols and support prevention of CS.