Methods: Using a mandatory field on the nurse triage form of the electronic medical record (EMR), patients 13-65 years of age seen on Main Campus (separate Adult and Pediatric ED) and a satellite ED (Livingston ED) are told they will be screened for HIV unless they decline. An automatic HIV Antigen/Antibody order is linked to the “Yes” option (agree to test). Results return in about an hour and are disclosed by the ED provider. Patients with reactive results are counseled briefly by the ED provider and linked to primary HIV care by our linkage-to-care team available in the ED. A review of the program using descriptive data and other analysis using t-test and Mann-Whitney where appropriate.
Results: Over 41,000 age-eligible patients (56% female, 44% male) were encountered since project initiation – average age was 36 years. 9572 patients (23%) agreed to be screened, while 8325 patients (20%) actually underwent testing. African-Americans accounted for a quarter of those tested, while 57% were male and the average age was 34.7 years. We identified 23 previously undiagnosed patients, among them 7 acute infections. All but 4 patients have been successfully linked to primary HIV care (87%). Over half of newly identified patients had been seen in our EDs at least once within the prior 2 years. Overall ED length of stay (LOS) for those tested was not significantly longer than those who declined testing (268 and 259 minutes, respectively).
Conclusion: Implementation of routine HIV screening in the ED has proven to be more arduous than anticipated but has uncovered previously undiagnosed and highly infectious individuals. While we have discovered more acute infections that anticipated, our testing acceptance rate remains less than 30%. Performance improvement activities have centered around delivery of screening verbiage by the triage nurse, incentivizing improved acceptance rates, and utilizing the EMR to eliminate work-arounds.
M. Bolton, Gilead: Grant Investigator , Research grant
See more of: Poster Abstract Session