title: A Comparison of Parallel and Integrated Models for Implementation of Routine HIV Screening in a Large, Urban Emergency Department.
abstract: OBJECTIVE
  This study compared two approaches for implementation of non-targeted HIV screening in the emergency department (ED): (1) designated HIV counselors screening in parallel with ED care and (2) nurse-based screening integrated into patient triage.
  
  
  METHODS
  A retrospective analysis was performed to compare parallel and integrated screening models using data from the first 12 months of each program. Data for the parallel screening model were extracted from information collected by HIV test counselors and the electronic medical record (EMR). Integrated screening model data were extracted from the EMR and supplemented by data collected by HIV social workers during patient interaction. For both programs, data included demographics, HIV test offer, test acceptance or declination, and test result. A Z-test between two proportions was performed to compare screening frequencies and results.
  
  
  RESULTS
  During the first 12 months of parallel screening, approximately 120,000 visits were made to the ED, with 3,816 (3%) HIV tests administered and 65 (2%) new diagnoses of HIV infection. During the first 12 months of integrated screening, 111,738 patients were triaged in the ED, with 16,329 (15%) patients tested and 190 (1%) new diagnoses. Integrated screening resulted in an increased frequency of HIV screening compared with parallel screening (0.15 tests per ED patient visit vs. 0.03 tests per ED patient visit, p<0.001) and an increase in the absolute number of new diagnoses (190 vs. 65), representing a slight decrease in the proportion of new diagnoses (1% vs. 2%, p=0.007).
  
  
  CONCLUSIONS
  Non-targeted, integrated HIV screening, with test offer and order by ED nurses during patient triage, is feasible and resulted in an increased frequency of HIV screening and a threefold increase in the absolute number of newly identified HIV-positive patients.
authors: Emory University, Department of Emergency Medicine, Grady Health System, Atlanta, GA.
authors: Abigail
authors: A
authors: Hankin
authors: Emory University, Department of Emergency Medicine, Grady Health System, Atlanta, GA.
authors: Heather
authors: H
authors: Freiman
authors: Emory University, Southeast AIDS Training and Education Center, Atlanta, GA.
authors: Brittney
authors: B
authors: Copeland
authors: Emory University, Department of Emergency Medicine, Grady Health System, Atlanta, GA.
authors: Natasha
authors: N
authors: Travis
authors: Emory University, Department of Emergency Medicine, Grady Health System, Atlanta, GA.
authors: Bijal
authors: B
authors: Shah
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration; D003955:Diagnostic Tests, Routine / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration*; D006801:Humans; D007258:Informed Consent; D008297:Male; D017146:Models, Organizational; D012189:Retrospective Studies