Beyond sexual assault: Feasibility of emergency contraception clinical guideline development in the context of adolescent unprotected consensual sex
Awarded 2014
Complex Family Planning Fellowship Research
Amber Truehart, MD
University of Chicago

Background: For many adolescents the Emergency department (ED) may be their first or only contact with the health care system for sexual and reproductive health yet many ED providers rarely discuss EC outside cases of sexual assault. Clinical guidelines, or recommendations for effective and uniform clinical practice, have been shown to improve clinical care. There are few criteria for introducing evidenced-based practices into clinical care yet factors have been described that when present limit guideline development; these factors are termed “Killer B’s”.
Objectives: In order to potentially improve adolescent EC counseling/provision in the setting of unprotected consensual sex in the emergency room we used the “Killer B’s” framework to assess emergency medicine resident’s perceptions of guideline feasibility.
Methods: An online survey was emailed to all US based emergency medicine residency program directors and administrators for resident distribution. Survey questions assessed resident’s individual demographics and institutional characteristics, perceptions of the need for EC among their adolescent population, attitudes, beliefs and practices on adolescent EC counseling and/or provision, and EC provision barriers.
Important Findings: Three hundred thirty residents met inclusion criteria. All training years and U.S regions were represented. Most participants reported an academic (80.5%) and non-religious (86.0%) hospital affiliation. 84.7% of residents reported learning “much too little” (37.6%) or “somewhat too little” (47.1%) about EC during training. Residents believed greater than 50% of adolescents seen in the ED were sexually active. 83% of residents believe EC is within their scope of practice and 73% of residents believe adolescents would be interested in EC counseling while at the Emergency department. The most common barriers reported to EC counseling/provision included insufficient knowledge, forgetting or not thinking to counsel, worry about lack of follow up and time constraints in the emergency department. Resident reported that insufficient knowledge and forgetting to counsel could easily be overcome while it would be harder to overcome lack of follow up and time constraints. Composite scores of key “Killer B” questions suggested that guideline development would be feasible.
Conclusion: The need for EC in the context of adolescent unprotected consensual intercourse in the ED meets Killer B criteria, making it feasible to create applicable guidelines for adolescent EC counseling/provision in this context.