Implementation of an electronic health record automatically linking HIV/hepatitis C virus screening to laboratory ordering for adult patients was found to be more effective than a nurse-driven protocol, according to data published in the Annals of Emergency Medicine.
Investigators employed a before-after comparative effectiveness cohort study to compare the numbers of patients screened and the number of newly diagnosed infections in the emergency department, using either the nurse-order screening algorithm protocol or the automated-laboratory-order algorithm. Each algorithm was assessed for 5 months, and all patients aged 18 to 75 years who were receiving treatment during the 5-month periods were eligible.
The differences in the percentage of patients receiving screening for HIV using each protocol was 33.9% during the automated protocol vs 19.6% during the nurse-driven protocol (difference, 14.3%; 95% CI, 13.4%-15.1%). Differences in hepatitis C screening between automated and nurse-driven protocols were 35.1% vs 14.2%, respectively (difference, 20.9%; 95% CI, 20.1%-21.7%). During the automated protocol, more patients had newly diagnosed infections: 23 vs 17 for HIV, and 101 vs 29 for hepatitis C virus. Results were also more often available before discharge during the automated protocol: 87.2% vs 65.1% for HIV, and 90.0% vs 65.4% for hepatitis C virus. Also, fewer patients underwent repeated screening during the automated protocol for HIV and hepatitis C, at 1.6% vs 5.8% and 1.3% vs 4.5%, respectively.
Although both protocols failed to achieve universal screening according to the Centers for Disease Control and Prevention definitions, an electronic health record algorithm that links non-targeted opt-out HIV and hepatitis C virus screening to physician laboratory ordering was “more effective and better integrated than a model reliant on nursing staff to routinely offer screening.” The use of electronic records in most emergency departments in the United States also means this method could be easily replicated; many rural and suburban areas will likely benefit from the practice of expanding hepatitis C virus screening in light of the “widespread nature of the opioid epidemic in the United States.” Investigators also found that one third of newly diagnosed patients with hepatitis C were outside of the birth cohort, providing further support for a policy of non-targeted screening for all adults, and recommend that the automated model be the standard for future programs.
White DAE, Todorovic T, Petti ML, Ellis KH, Anderson ES. A comparative effectiveness study of two nontargeted HIV and hepatitis C virus screening algorithms in an urban emergency department [published online June 21 2018]. Ann Emerg Med. doi: 10.1016/j.annemergmed.2018.05.005.