An Automated Best Practice Advisory Increases Both Routine HIV Screening and HIV Co-Testing with Sexually Transmitted Infections in the Emergency Department.

BACKGROUND: There is increasing interest in improving routine HIV screening in emergency departments (EDs) and increasing HIV co-testing rates among patients tested for sexually transmitted infections (STIs), who are considered at elevated risk of acquiring HIV.

METHODS: This is a retrospective review of all ED encounters at a large, urban ED with an existing HIV screening program for seven months before (November 1, 2018, to May 30, 2019) and after (June 1 to December 31, 2019) the implementation of a best practice advisory (BPA) prompting universal HIV and syphilis screening.

RESULTS: The study included 14,767 unique encounters, with 3,982 pre-implementation encounters and 10,785 post-implementation. After implementation, HIV testing increased 242%, from 2,851 tests to 9,757, and syphilis testing increased 326%, from 2,191 tests to 9,330. The proportion of encounters for urogenital STI testing without HIV co-testing decreased by 10.3%, from 43.6% to 33.3%.

DISCUSSION: An automated EMR prompt can have a huge impact on both HIV and syphilis testing rates, as well as the rate of missed opportunities for co-testing among patients undergoing STI testing.

CONCLUSIONS: Hospitals should support screening with automated alerts to help meet quality metrics, improve screening rates, and reduce missed opportunities for screening in vulnerable patients.