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Implementation of an alert system for the care cascade of Hepatitis C infection in patients undergoing elective
Jae Seung Lee1, Ho Soo Chun2, Hye Won Lee1
1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea; Yonsei Liver Center, Severance Hospital, Seoul, South Korea.
Background:
A key barrier to an effective care cascade for Hepatitis C virus (HCV) is limited awareness, especially among patients undergoing elective surgery. To address this issue, we introduced an electronic medical record (EMR)-based automatic alert system in 2021 to enhance surgical healthcare providers' awareness of HCV screening and referral rates.
Methods:
The alert system was designed to alert surgeons to order preoperative HCV antibody testing for patients undergoing elective surgery before admission and, at discharge, recommend hepatology consultation for patients with positive HCV antibody testing.
Results:
The system significantly improved the HCV screening rate by 73,834 (96.8 %) among 76,310 patients undergoing surgery after system implementation, compared to 106,854 (82.8 %) among 129,065 patients between 2016 and 2020 (P < 0.001). Among them, the system alerted 12,048 (16.3 %) cases, and 463 patients tested positive for HCV antibodies. However, only 42 (15.3 %) were referred out of 275 (59.4 %) who required hepatology consultation. Linkage failure was associated with other surgery departments than hepatobiliary and transplant surgery departments (odds ratio [OR]=5.940, 95 % confidence interval [CI], 3.080-12.410, P < 0.001) and shorter hospitalization duration (OR=0.980, 95 % CI, 0.950-0.990, P = 0.012).
Conclusion:
The EMR-based automatic alert system effectively increased HCV screening for patients undergoing elective surgery before admission. However, it could not link them to care cascade in surgery departments. Combining more proactive approaches would be beneficial, such as reflex testing or a call-back strategy.
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