title: Routine, rapid HIV testing of medicine service admissions in the emergency department.
abstract: OBJECTIVE
  We identify undiagnosed HIV among adult emergency department (ED) patients awaiting medicine admission through rapid testing, expedite their redirection to the inpatient HIV service, and improve linkage to ambulatory HIV care.
  
  
  METHODS
  Two ED health educators offered rapid testing to patients aged 18 to 64 years from the high-acuity ED area from which most medicine admissions originate. Heath educators obtained consent, obtained fingerstick blood, and performed point-of-care testing. Patients with reactive results received counseling, confirmatory testing, and appointments at the affiliated HIV clinic.
  
  
  RESULTS
  Between March 1, 2008, and February 28, 2009, 4,755 patients received testing. Thirty patients (0.6%) had received a new diagnosis of HIV; 26 were admitted and redirected to the HIV service. Characteristics of HIV positive patients were mean age 38 years, 87% men, 64% black, and 33% Hispanic; 76% had CD4 counts less than 200 cells/mm(3); 67% had HIV-related diagnoses; and 93% reported for ambulatory HIV care in a median of 10 days. During 2 preceding years, these patients had a mean of 3 previous health system visits without testing. During a 6-month quality assurance interval of the 5,340 ED medicine admissions, 31% of patients were eligible for testing, of whom 88% received testing (1% positive) and 12% declined; 29% of the 5,340 were not approached for testing; and 40% were deemed ineligible. Common reasons for ineligibility included older age, recent previous test, and known HIV-positive status.
  
  
  CONCLUSIONS
  Patients who receive a diagnosis of HIV in our ED before admission are extremely ill, most having AIDS. Targeted HIV screening of ED patients awaiting hospital admission facilitated timely diagnosis and reliable linkage to inpatient and outpatient HIV care.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, John H. Stroger, Jr Hospital of Cook County, Chicago, IL 60612, USA. rlubel@gmail.com.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Lubelchek
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kroc
authors.forename: David L
authors.initials: DL
authors.lastname: Levine
authors.forename: Kathleen G
authors.initials: KG
authors.lastname: Beavis
authors.forename: Rebeca R
authors.initials: RR
authors.lastname: Roberts
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002641:Chicago / Q000453:epidemiology; D003266:Continuity of Patient Care; D003376:Counseling; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007258:Informed Consent; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012044:Regression Analysis; D055815:Young Adult