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Key Players: Emergency Department
Leadership
ED leaders are the clinical and administrative directors of the ED. These include:
- Medical chiefs
- Formal and informal physician and nurse leaders
- Administrative directors
- Residency and fellowship directors
ED leaders can:
- Create a supportive environment for HIV testing
- Champion the effort among hospital administrators and ED staff
- Elicit buy-in among staff who would be responsible for the program
- Help secure human resources to oversee and execute the program
ED leaders, particularly in high-prevalence settings, have acknowledged that knowing a patient's HIV status can promote accurate diagnosis and treatment of patients in the ED. These leaders are concerned with increased burden on their staff and the disruption of service flow in the ED. Piloting HIV testing on a small scale will help demonstrate the likely effect (or lack thereof) of HIV testing on ED operations.
top of this pageClinical Staff
Clinical staff could perform some or all aspects of HIV testing. While many would favor knowing their patients' HIV status, in practice, they might give HIV testing low priority because of the patient's presenting condition and history or because they are simply too busy. Clinical staff may be concerned about the time required for informed consent and counseling, especially when the ED is overburdened and understaffed. They might more readily support a parallel, nonintrusive testing service in the ED rather than incorporating testing into routine care.
top of this pageRegistration and Triage
These staff can:
- Be the patients' first point-of-contact for HIV testing in the ED by providing information, offering the test to patients, or taking specimens in triage
- Be an integral component of the program when the goal is universal testing
- Build awareness and create the expectation among patients that they can get tested and get their results
Of course, registration and triage can be chaotic environments. Additional responsibilities for HIV testing may be perceived as an increased burden on staff. See Operational Flow for more information on how to use registration and triage staff.
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