Opt-Out Screening for Blood-Borne Viruses in Trauma and Orthopaedic Admissions From the Emergency Department: Are We...

Background In the United Kingdom, blood-borne viruses (BBVs) such as Hepatitis B, Hepatitis C, and HIV continue to pose a significant health risk to the public. The national guidelines currently recommend that everyone attending the Emergency Department (ED) and having routine blood tests done is automatically offered testing for BBV, unless they choose to opt out. During their management, patients under the care of Trauma and Orthopaedics (T&O) are admitted from several different ED areas, which makes them a key group for analysing how consistently screening recommendations are adhered to. Objectives The aim of this study was to evaluate the efficiency of the national BBV opt-out screening guidelines' implementation for patients admitted to the T&O service from the ED and to analyse whether there are differences in screening practices across the various ED areas. Methods A retrospective clinical audit at Queen Elizabeth Hospital Birmingham was conducted, reviewing all T&O patients admitted from the ED between the 1^st of February and the 15^th of March 2025. Patients who were already screened within the past 12 months were not re-tested but were still recorded as compliant with screening guidelines as per hospital policy. The data were extracted from electronic clinical records and laboratory systems. Descriptive statistics and chi-square tests were then used to assess overall screening compliance and to compare screening rates across different ED areas (Resuscitation, Majors, and Minors/Others). Results Among the 89 acceptable admissions, the mean age was 59 ± 22 years. Overall, 53 (59.6%) patients had been tested for BBVs at the time of admission, while another 14 (15.7%) had a valid test from the past year. This brought total compliance with the screening guidelines to 67 (75.3%). The remaining 24.7% were neither screened nor had reasons documented for opting out. Six patients (6.7%) had tested positive for Hepatitis C, including three who were newly diagnosed. Screening rates varied across ED areas. Resuscitation had the highest compliance, with 24 (88.9%) patients screened, followed by Majors (33, 71.3%) and Minors/Other (10, 62.5%). These differences, however, did not reach statistical significance (p = 0.111). Conclusion Even though the majority of T&O admissions received BBV screening, almost one in four eligible patients were not tested, which represents a missed opportunity for early detection and prevention. Higher screening rates in the Resuscitation Unit suggest that automated testing pathways can improve compliance. Introducing BBV tests into the routine ED blood panels, along with increasing staff awareness, and ensuring proper documentation and record when patients opt out, could assist in reducing the gaps.