The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Identifying ED patients with previous abnormal HIV or hepatitis C test results who may require additional services
Am J Emerg Med. 2020 May 11;38(9):1831-1833. doi: 10.1016/j.ajem.2020.05.020.Online ahead of print.
Andrew H Ruffner1, Rachel M Ancona2, Catherine Hamilton3, Francisco J Fernandez4, Kiran A Faryar5, Bennett H Lane6, Michael S Lyons7
Author information
1University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America.
2University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America. Electronic address: anconarm@ucmail.uc.edu.
3University of Cincinnati Health, 3200 Burnet Ave, Cincinnati, OH 45229, United States of America. Electronic address: drdobro@cinci.rr.com.
4University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America. Electronic address: fernanfj@ucmail.uc.edu.
5University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America. Electronic address: faryarka@ucmail.uc.edu.
6University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America. Electronic address: lanebt@ucmail.uc.edu.
7University of Cincinnati College of Medicine, Department of Emergency Medicine, Medical Sciences Building Room 1654, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769, United States of America. Electronic address: lyonsme@ucmail.uc.edu.
Abstract
Objectives: Routine emergency department (ED) HIV or HCV screening may inadvertently capture patients already diagnosed but does not specifically prioritize identification of this group. Our objective was to preliminarily estimate the volume of this distinct group in our ED population through a pilot electronic health record (EHR) build that identified all patients with indications of HIV or HCV in their EHR at time of ED presentation.
Methods: Cross-sectional study of an urban, academic ED's HIV/HCV program for previously diagnosed patients August 2017-July 2018. Prevention program staff, alerted by the EHR, reviewed records and interviewed patients to determine if confirmatory testing or linkage to care was needed. Primary outcome was total proportion of ED patients for whom the EHR generated an alert. Secondary outcome was the proportion of patients assessed by program staff who required confirmatory testing or linkage to HIV/HCV medical care.
Results: There were 65,374 ED encounters with 5238 (8.0%, 95% CI: 7.8%-8.2%) EHR alerts. Of these, 3741 were assessed by program staff, with 798 (21%, 95% CI: 20%-23%) requiring HIV/HCV confirmatory testing or linkage to care services, 163 (20%) for HIV, 551 (69%) for HCV, and 84 (11%) for both HIV and HCV services.
Conclusions: Patients with existing indication of HIV or HCV infection in need of confirmatory testing or linkage to care were common in this ED. EDs should prioritize identifying this population, outside of routine screening, and intervene similarly regardless of whether the patient is newly or previously diagnosed.