An Evaluation of Human Immunodeficiency Virus (HIV) Screening After Implementation of an Electronic Medical Record (EMR) Reminder

Background. The USPSTF guidelines on HIV screening proposed that all persons age 15–65 should be screened once for HIV, with more frequent screening for persons in high prevalence settings. In March 2015, an electronic medical record (EMR) HIV screening reminder was embedded into the emergency trauma department (ETD) triage documentation, inquiring about HIV screening within the past 12 months. We evaluated the impact of this intervention on HIV screening practices in patients admitted to medicine. Methods. A retrospective chart review was performed on 454 patients admitted to the medicine service at University Hospital from 1 December 2015 to 25 December 2015 and compared them to December 2014 admissions. Data collected included current HIV infection and documented HIV screening (prior and current admission). If screened during admission or past 12 months, the ordering physician's service was recorded. Patients considered eligible for screening were those without a history of HIV or an HIV test >12 months prior to admission. Results. A total of 454 admissions were reviewed, 39 (9%) had a prior history of HIV and 124 (27%) were screened for HIV in the prior 12 months. Two hundred ninety-one patients were considered eligible for screening. Ninety-nine (34%) patients had no documented lifetime HIV screening history and 156 (54%) patients were screened during admission. Ninety-one (58%) test were ordered by the ETD service, and 64 (41%) by medicine. Of those screened within 12 months, 73% of the most recent HIV tests were ordered by the ETD. Conclusion. The overall HIV screening rate of eligible patients admitted to medicine more than doubled from 23% to 54%. This increase was led primarily by ETD efforts, as patients screened by the medicine service during admission remained virtually unchanged (18% versus 22%, respectively). Although implementation of the EMR reminder has contributed to successes in the ETD, there continues to be room for improvement in HIV screening on the inpatient medicine service. Disclosures. G. Sugalski, Gilead: Grant Investigator, Research grant; S. Swaminathan, Gilead: Grant Investigator, Research grant