1042. A Missed Opportunity: Identifying Barriers to Inpatient HIV Screening
Session: Poster Abstract Session: Knowledge, Attitudes, Screening, and Prevention
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Background: In 2010 New York State legislation amended public health law, Article 27F, to require that HIV testing be offered to all patients, age 13- 64, in emergency departments and in primary care and inpatient settings. This study aimed to define the percentage of patients age 18-64 admitted to our department that were offered HIV screening, to identify barriers to offering routine HIV testing and provide solutions for increasing rates of screening.

Methods: The first 134 medical records of all patients admitted to the department of medicine at Lenox Hill Hospital in June 2011, were reviewed for the presence or absence of a rapid HIV antibody test or documentation of offering HIV screening. Patients with known HIV infection, admitted for chemotherapy, requiring ICU admission or having terminal disease were excluded. We randomly surveyed 37 internal medicine residents about their knowledge and attitude regarding HIV screening. Finally, three solutions to facilitate HIV screening were developed based on the results of the survey.

Results: Of 134 patients, 42 were excluded based on the exclusion criteria mentioned above. Of the remaining patients, 8/87, or 9.1% were offered or screened for HIV. The resident survey found that 81% were aware of the mandate for HIV testing and 75% understood the difference between “opt in“ and “opt out” testing, however 43% falsely believed that written consent was required for rapid HIV testing. 38% did not know how to order the rapid HIV screening test. Three major themes emerged regarding housestaff attitudes towards HIV testing; 32% felt they were too busy and didn’t remember, 24% felt HIV screening was not clinically relevant, and 22% felt their patients were not at risk. 78% of residents said adding an HIV screening option to the EMR would increase their rate of HIV screening. Three interventions were instituted to improve inpatient HIV screening; residents were educated regarding rapid HIV screening, reminders were added to the EMR, and the ordering of the test was simplified.

Conclusion: Inpatient HIV screening does not meet the state and national mandate for screening. To provide our patients with the best medical care, and to comply with New York State law we should incorporate HIV screening into routine admissions to the hospital.

Marelle Yehuda, MD1, Robert Graham, MD, MPH1 and Laden Ahmadi, MD2, (1)Internal Medicine, Lenox Hill Hospital, New York, NY, (2)Lenox Hill Hospital, New York, NY

Disclosures:

M. Yehuda, None

R. Graham, None

L. Ahmadi, None

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