Operational Flow

What are the "natural moments" for HIV testing in the ED?

In the pages that follow, we suggest opportunities during the visit and patient areas where EDs may incorporate HIV testing for patients. Our intent is to generate ideas about how HIV testing might work in your facility with minimal disruption to the existing operational flow. Please consider this information in the context of your ED's selected approach.

After reading these pages, we encourage you to spend time observing your EDs' flow and services at various times of the day and various days of the week. This will inform the time and resources required to complete the testing process and help determine what steps are reasonable at what points of service. Observation will also help identify any unanticipated bottlenecks that may impede service.

While observing, consider these aspects of the ED's design:

• Is there an urgent care or fast-track setting?
• Is there an observation unit?
• Where do ambulatory patients wait to see the provider? Is there more than one location?
• At what points in the visit do patients wait for 30 minutes or more?
• Is the ED an open ward where there are many beds in one room, separated by curtains? Or are there private rooms?
• Are there any private rooms or spaces where sensitive results could be disclosed?
• Is there a STAT lab in the ED or other temperature-controlled space for storing and running rapid HIV tests at the point-of-care?
• Is there a place where testing staff can complete paperwork and have space to store materials?

Consider design and flow issues in conjunction with these program elements:

• What ED patients will likely receive HIV tests? What are the goals of the program?
• Will testing will be provided on an opt-out basis, or will a streamlined pretest counseling approach be employed?
• Which staff members are available to offer tests to patients, run HIV tests, and deliver results?

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General "Rules" for HIV Testing in the ED

Some general guidelines for designing and implementing HIV testing in the ED come from the field. They are:

1. Be as seamless as possible. Do not interfere with ED services.
2. Show benefit: Make HIV counselors available when a provider refers a patient for HIV testing
3. Show benefit: Refer all HIV-positive patients identified in the ED to the Infectious Disease/HIV Team to do follow up for new positives and primary care referral
4. Show benefit more broadly: Do all testing for source and employees in occupational exposures