Linking to Care
How will the ED facilitate the linkage to care?
Facilitating the linkage to care for patients with HIV-positive test results will be a relatively small, albeit crucial, component of the HIV testing in the emergency department. EDs are not geared to provide extensive follow-up services. The role of the ED in terms of linking to care is to inform the patient how they can access primary and specialty care and to aid patients in setting up their initial visit. This can be performed by counselors, clinical staff, or a linkage-to-care liaison from the HIV or ID clinic. See Staffing for more information.
Considerations that should be factored into the linkage-to-care process include:
- Does the hospital maintain onsite or community-based infectious disease or primary care clinics that can treat and manage the care of patients with HIV?
- What other, unaffiliated clinics are available in the community? If the ED refers patients to these clinics, does a formal agreement or contract need to be in place?
- What processes will the ED and each referral clinic use to communicate about new patients?
- Will ED staff, counselors, or clinic staff walk patients to the clinic to initiate the follow-up process? This works well when the clinic is co-located or in close proximity to the ED.
- Will the clinic maintain same-day appointments for patients tested in the ED?
- Will the clinic have standing appointment times for which testing staff can schedule patients?
- How will the ED provide real-time, daily, or other timely updates to clinic staff on new patients?
- How will the clinic report information back to the ED on the number of patients who keep their initial visit? This will be important information for the ED to track its effectiveness in linking patients to care.
- What measures can be taken if follow-up rates are low? Transportation vouchers, retail gift certificates, child care, and transportation service are some incentives that have been used at different sites with varying levels of success.