TOP 19 - Increasing Oral Contraception Pill Prescriptions in the Pediatric Emergency Department

Publication Number: 4721.TOP 19

Svetlana Duvidovich, Icahn School of Medicine at Mount Sinai, NY, NY, United States; Paige Rattner, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Ashley London, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Jacqueline Ryder, Mount Sinai Hospital, Sayville, NY, United States; Morgan Bowling, Icahn School of Medicine at Mount Sinai, New York, NY, United States

Background: Access to high-quality family planning services has become increasingly limited, particularly for adolescents, prompting many to seek care in the emergency department (ED). The ED has been identified as a "golden opportunity" to counsel young adults on contraception and initiate birth control. However, many emergency and pediatric emergency department (PED) providers lack formal training and therefore experience discomfort providing comprehensive reproductive health counseling or initiating methods such as oral contraceptive pills (OCPs).

Objective: To evaluate whether provider education, implementation of a clinical decision support tool, and electronic medical record (EMR) integration led to an increased rate of OCP prescriptions among interested and eligible adolescent patients discharged from the PED.

Design/Methods: A retrospective chart review was conducted from November 1, 2023, to October 31, 2025, including all adolescent patients (ages 11-21) discharged from the PED with an OCP prescription. The study period encompassed one year before and one year after the following interventions: (1) provider education on contraceptive options and counseling, (2) implementation of a clinical decision support tool for OCP prescribing, and (3) EMR integration to enhance provider workflow for reproductive care services. Institutional review board approval was obtained.

Education sessions consisted of single 45-minute trainings delivered to emergency medicine faculty, fellows, and residents, as well as pediatric and family medicine residents rotating through the PED of an urban, academic, tertiary-care hospital. Sessions addressed identification of eligible patients, patient-centered counseling strategies, contraceptive safety, prescribing processes, and linkage to outpatient follow-up. Seven single trainings were conducted.

The clinical decision support tool guided providers in assessing OCP eligibility and selecting the appropriate formulation (combined estrogen-progestin or progestin-only). To further streamline workflow, the tool was integrated into the EMR with an order set enabling prescription of two pre-approved OCP formulations developed in collaboration with Obstetrics/Gynecology (OBGYN). The order set also included referral options to OBGYN or Adolescent Medicine, as well as standardized discharge instructions and documentation templates.

Data extraction has been completed, and analysis are ongoing. We hypothesize that the interventions will be associated with an increase in OCP prescriptions during the post-intervention period.

Initiation of Oral Contraception Pills from the ED
Clinical decision support tool for guiding providers on OCP initiation

Electronic Medical Record Order Set
Electronic Medical Record Integration of oral contraception pill prescriptions