Effect of Routine Opt-Out HIV Screening on Emergency Department Operational Metrics: Results From the Pragmatic...

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Services Research

Background:

• Emergency departments (EDs) are critical points for identifying undiagnosed HIV infections.
• Routine opt-out HIV screening strategies aim to increase testing rates and linkage to care.
• Evaluating the operational impact of integrated HIV screening on ED patient throughput is essential.

Purpose of the Study:

• To assess the effect of routine opt-out HIV screening on emergency department (ED) patient throughput.
• To compare the operational impact of three distinct opt-out HIV screening strategies.

Main Methods:

• A multicenter, prospective, pragmatic 3-arm randomized clinical trial was conducted.
• The study nested within a time-series quasi-experiment to evaluate operational metrics.
• Hierarchical regression models analyzed associations between HIV screening and ED wait times, length of stay, boarding, door-to-door time, and patients leaving before treatment.

Main Results:

• HIV screening was associated with a small increase in average wait time (1.4 minutes).
• Length of stay for admitted patients and door-to-door time decreased by 18 minutes.
• A slight increase in patients leaving before treatment was observed (prevalence ratio: 1.10).

Conclusions:

• Integrated routine opt-out HIV screening demonstrated small, nonclinically significant increases in wait times and patients leaving before treatment.
• No significant changes were observed in length of stay, boarding time, or door-to-door time.
• Routine opt-out HIV screening can be integrated into ED care with manageable operational effects.