Emergency Departments

Emergency Departments are highly encouraged to integrate routine HIV screening into their clinical care. Apart from being able to reach hundreds of individuals at the same time, knowing a patient’s HIV status can prove to be a useful diagnostic tool. We realize that the ED is a unique setting due to its fast paced nature, so we have provided some helpful tools (HWA) to address  some of the most common concerns facilities have shared with us.  For more information on expanded testing  at our current ED sites, please click here.

Sample ED Testing Flowchart

Concern:  The ED staff already have a lot of time-consuming responsibilities and cannot take up any more

HWA: Screening for HIV does not need to be a time-consuming process. Providers can test patients in as little as 3 minutes using conventional testing methods, or as little as 10 minutes using rapid testing technology.

Concern:  Prevention counseling is laborious and time-consuming

HWA: Per the revised CDC guidelines, prevention counseling (i.e. risk assessment and risk reduction planning) is no longer a prerequisite for HIV testing. However, Pennsylvania’s Act 148  requires that specific educational information be made available to the patient in pre-test counseling. We have developed pre and post test educational literature (Resources), which help to supplement and accelerate the counseling process. In lieu of written materials, a 5-minute video is also available, and this model has been demonstrated to be highly successful in emergency rooms.

Concern:  The consent process is too involved

HWA: Not anymore. We have developed a short consent form (Resources) which meets PA state law requirements, and are in the process of developing a generalized medical consent which includes HIV screening in accordance with the CDC guidelines.  

Concern: Our ED staff do not have the time to deal with ‘reactive’ results

HWA:  If a patient’s specimen is reactive using rapid test technology, then the patient is gently advised that this does not necessarily mean the presence of HIV, but that additional specimen is needed for confirmatory testing.  There is also available literature to hand out to the patient (Resources). In the event that the confirmatory specimen comes back positive (usually in 2-5 days), then hospital protocol is followed in giving positive results (for example, notifying an infectious disease physician).  Some hospital systems have a collaboration with HIV clinics, and their EDs choose to have the patients report to the clinics for the notification process. Thus, ED staff are not involved in the final notification unless they wish to be.

Concern: How will expanded testing be sustainable after cessation of grant funds?

HWA: Some of our programs have succesfully billed for conventional HIV testing, and we provide technical assistance with achieveing this. More information on coding guidelines are in the Quick Links section. We are in the process of developing a similar protocol for rapid HIV testing.