Abstract
Session F presented Friday, September 28, 11:30 am-12:30 pm
Purpose: HIV infection is a health concern, particularly in the rural, South. The Centers for Disease Control and Prevention (CDC) recommends routine, opt-out screening during health visits. Emergency departments (ED) are the sole source of care for many patients. Cost of testing and lack of follow-up are common rationale for failed ED screening programs. The hypothesis is to successfully implement an opt-out HIV testing program in an academic ED, identify patients with HIV and link them to treatment.
Design: This implementation science study utilized two pillars and the Plan-Do-Study-Act (PDSA) quality improvement model. The two pillars were: integration of testing into ED workflow and use the electronic medical record (EMR) to prompt testing. PDSA methodologies ensured adoption. An EMR alert prompted nursing for verbal consent and ordering HIV test for eligible patients. Following guidelines, we removed previously required signed consent and counseling.
Setting: A rural, academic medical center serving as a Level 1 trauma and regional referral center. Serving Eastern North Carolina, the ED saw 130,000 patients in 2017. The hospital serves a socioeconomically disadvantaged population, with 58% government, 24% commercial and 18% self-pay. Our area, with an HIV seropositive rate above 0.1% is regarded in need of HIV services.
Participants/Subjects: All ED staff participated. All eligible patients presenting to the ED, age between 18 and 65 years, no documentation of HIV positivity or of HIV test within the past year, and orders for bloodwork were included in the intervention. Prospective data collected since March, 2017. This study was exempt from IRB oversight. Methods: We implemented an opt-out strategy for routine testing. Physician and nursing staff were educated on project goals, regulatory requirements, cost and process for testing. Important to communicate were that special consent was not required and the plan for follow-up and care linkage. When completing triage, the EMR scanned for eligibility and fired an alert, prompting nurse to inform the patient of opt-out testing unless they declined. Grant support covered the cost for uninsured patients. Results were routed to linkage coordinator for confirmatory testing, counseling for high risk patients, and if positive, link them to care. We compared pre and post rate of testing, noting the number of tests and positive results.
Results/Outcomes: In year prior to study, only 121 HIV test were ordered in the ED. Many of these for blood exposures. Eighteen of 5,999 (0.3% seropositive rate) tested positive for HIV during the study. Among positive, 16.7% were women and 83.3% men. Median age was 36.5 years (SD = 14.9). 88.9% positive were Black/African-American and 11.1% White. Twelve were newly diagnosed, 5 were previously known positives in care, and 1 of these previously known positive re-engaged in care. The most common presenting complaints were chest pain (16.7%) and sore throat (16.7%).
Implications: We successfully implemented opt-out ED HIV screening. Successfully mitigating the staff concerns of special consent and uncertainty of follow-up, allowed us to diagnose several patients who would not have been diagnosed by high-risk or opt-in testing.
Sigma Membership
Non-member
Type
Poster
Format Type
Text-based Document
Study Design/Type
N/A
Research Approach
N/A
Keywords:
HIV, PDSA, HIV Screening
Recommended Citation
Hill, Carol; Reeder, Timothy; Syers, Brenda; Dortche, Ciarra; and Fadul, Nada, "Opt-out HIV testing in an academic emergency department" (2019). General Submissions: Presenations (Oral and Poster). 154.
https://www.sigmarepository.org/gen_sub_presentations/2018/posters/154
Conference Name
Emergency Nursing 2018
Conference Host
Emergency Nurses Association
Conference Location
Pittsburgh, Pennsylvania, USA
Conference Year
2018
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Opt-out HIV testing in an academic emergency department
Pittsburgh, Pennsylvania, USA
Session F presented Friday, September 28, 11:30 am-12:30 pm
Purpose: HIV infection is a health concern, particularly in the rural, South. The Centers for Disease Control and Prevention (CDC) recommends routine, opt-out screening during health visits. Emergency departments (ED) are the sole source of care for many patients. Cost of testing and lack of follow-up are common rationale for failed ED screening programs. The hypothesis is to successfully implement an opt-out HIV testing program in an academic ED, identify patients with HIV and link them to treatment.
Design: This implementation science study utilized two pillars and the Plan-Do-Study-Act (PDSA) quality improvement model. The two pillars were: integration of testing into ED workflow and use the electronic medical record (EMR) to prompt testing. PDSA methodologies ensured adoption. An EMR alert prompted nursing for verbal consent and ordering HIV test for eligible patients. Following guidelines, we removed previously required signed consent and counseling.
Setting: A rural, academic medical center serving as a Level 1 trauma and regional referral center. Serving Eastern North Carolina, the ED saw 130,000 patients in 2017. The hospital serves a socioeconomically disadvantaged population, with 58% government, 24% commercial and 18% self-pay. Our area, with an HIV seropositive rate above 0.1% is regarded in need of HIV services.
Participants/Subjects: All ED staff participated. All eligible patients presenting to the ED, age between 18 and 65 years, no documentation of HIV positivity or of HIV test within the past year, and orders for bloodwork were included in the intervention. Prospective data collected since March, 2017. This study was exempt from IRB oversight. Methods: We implemented an opt-out strategy for routine testing. Physician and nursing staff were educated on project goals, regulatory requirements, cost and process for testing. Important to communicate were that special consent was not required and the plan for follow-up and care linkage. When completing triage, the EMR scanned for eligibility and fired an alert, prompting nurse to inform the patient of opt-out testing unless they declined. Grant support covered the cost for uninsured patients. Results were routed to linkage coordinator for confirmatory testing, counseling for high risk patients, and if positive, link them to care. We compared pre and post rate of testing, noting the number of tests and positive results.
Results/Outcomes: In year prior to study, only 121 HIV test were ordered in the ED. Many of these for blood exposures. Eighteen of 5,999 (0.3% seropositive rate) tested positive for HIV during the study. Among positive, 16.7% were women and 83.3% men. Median age was 36.5 years (SD = 14.9). 88.9% positive were Black/African-American and 11.1% White. Twelve were newly diagnosed, 5 were previously known positives in care, and 1 of these previously known positive re-engaged in care. The most common presenting complaints were chest pain (16.7%) and sore throat (16.7%).
Implications: We successfully implemented opt-out ED HIV screening. Successfully mitigating the staff concerns of special consent and uncertainty of follow-up, allowed us to diagnose several patients who would not have been diagnosed by high-risk or opt-in testing.