139 Successful Initiation of an Emergency Department-Based HIV and HCV Screening Program

Abstract

In May 2016, we initiated an ED-based age-cohort screening program for HIV/HCV based on 2006 revised CDC guidelines at Tampa General Hospital, then expanded our age-cohort for HCV screening to include young IVDU with a goal of maintaining seropositivity rate >= 6%. To accommodate this high volume testing, our process focused on taking the burden off providers by utilizing existing tools within our EMR (Epic). Initial involvement of risk management, IT, ED registration, laboratory, hospital executives, ED nursing staff, and providers at frequent periodic development retreats to discuss and refine our process led to buy-in across disparate groups of service lines and leaders. Our commitment to minimal workflow impact in our design led us to develop best practice alerts and automated testing, creating a cultural shift towards support of the large-scale new initiative. We track daily testing as a percentage of total ED volume with test cancelations and patient opt-outs to monitor variation within the system. One year from our program’s inception in May 2016, we now consistently test approximately 1,400 patients/month for HIV & HCV (using our expanded age range) – or about 100 ED patients/day. About 85,000 patients visit our ED and the prevalence of unknown disease may be as high as 0.3% for HIV (1.35% seropositivity in screened group, 230 HIV+ 2016-17) & 1.8% of all ED patients with HCV (8% seropositivity in screened population, 642 HCV Ab+ 2016-17). In 2017-2018, approximately 34,000 patients will be screened for HIV &/or HCV at TGH. In 2016-2017, we initially estimated we would conduct approximately 24,500 screening tests (17,000 HIV and 7,500 HCV). We met 86% of our total screening goals and completed over 21,000 screening tests (10,556 HIV and 10,500 HCV). We recommend frequent process review and early engagement of disparate hospital groups to ensure buy-in as well as open communication with front-line workers to minimize workflow impact and increase testing success. Harnessing existent EMR processes and integrating new electronic alerts into workflow also ensures maintenance of ED patient volume and quality of care. The creation of quality and operational reports to track BPA success and compliance assists in appreciating changing successes and challenges within the system. Our consistent monthly numbers, low variance in cancellations and variation in percentage tests by ED volume, give us an ability to make accurate and precise estimates for screening test volume in 2017 which will outpace our 2016 numbers given the reliability of the BPA process and its seamless integration with ED functionality.