Abstract
BackgroundRecent studies demonstrate high rates of previously undiagnosed hepatitis C virus (HCV) infection among patients screened in urban emergency departments (ED). Experts caution, however, that public health interventions, such as screening for infectious diseases, must not interfere with the primary mission of EDs to provide timely acute care. Increases in ED length of stay (LOS) have been associated with decreased quality of ED care.ObjectiveIn this study, we assess the influence of an integrated HCV screening protocol on ED LOS.MethodsThis was a retrospective cohort study analyzing timestamp data for all discharged patients over a 1-year period. The primary outcome compared the median LOS in minutes between patients who completed HCV screening and those who did not. Further analysis compared LOS for HCV screening by whether or not complete blood count (CBC) testing was conducted.ResultsOf 69,639 visits, 2,864 (4%) had HCV screening tests completed and 272 (9.5%) were antibody positive. The median LOS for visits that included HCV screening was greater than visits that did not include screening (151 versus 119 minutes, P < 0.001). Among the subset of visits in which CBC testing was conducted, there was no significant difference in median LOS between visits that also included HCV screening and those that did not (240 versus 242 minutes, P = 0.68).ConclusionIntegrated HCV screening modestly prolongs ED LOS. However, among patients undergoing other blood tests, screening had no effect on LOS. Programs may consider routinely offering HCV screening to patients who are undergoing laboratory testing.
Highlights
BackgroundThe Centers for Disease Control and Prevention recommend targeted hepatitis C virus (HCV) screening in health care settings for a “birth cohort” of patients born between 1945–1965, as well as those with identifiable risk factors, such as injection drug use.[1]
Among the subset of visits in which complete blood count (CBC) testing was conducted, there was no significant difference in median length of stay (LOS) between visits that included HCV screening and those that did not (240 versus 242 minutes, P = 0.68)
The final study sample consisted of 69,639 visits with complete LOS data, in which location of care was known and the patient was discharged. (Fig 1) Only discharged patients were included in the analysis
Summary
The Centers for Disease Control and Prevention recommend targeted hepatitis C virus (HCV) screening in health care settings for a “birth cohort” of patients born between 1945–1965, as well as those with identifiable risk factors, such as injection drug use.[1]. In April 2014, we integrated triage nurse HCV screening into ED clinical operations, utilizing a laboratory-based testing protocol and native staffing to offer, perform, and disclose results.[2] Because of concerns that HCV screening would increase ED length of stay (LOS) our protocol did not require patients to wait for the results of their HCV tests prior to discharge. Emergency department LOS is a well-accepted surrogate marker for crowding and has been associated with poor clinical outcomes.[9,10,11] Coeller et al demonstrated that ED LOS is negligibly affected by HIV screening, the generalizability of their findings is limited because a parallel staffing model and rapid oral swabs were utilized for testing.[12] To our knowledge, no such literature exists for HCV screening and for models that utilize native staffing and standard blood-based laboratory testing procedures.
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