Utilizing Continuous Quality Improvement Strategies for Improving HIV Screening Rates in a Rural Emergency Department
Abstract
Background: Memorial Health University Medical Center conducts opt-out HIV screening in its Adult Emergency Department (ED) for ages ≥18. Integrated technology-based algorithms attach HIV tests to lab orders. Consent at triage is documented in the medical record. Post-COVID monthly reports reviewed between January 2019-December 2023 identified a 46% reduction in patients receiving the standardized HIV test. We endeavored to better understand the factors leading to the decline HIV testing and implement improvement strategies.
Methods: Root cause analysis determined specific cause(s) for the lack of adult HIV testing. Identified contributing factors were increased patient volume, low staffing but high staff turnover, and change in registration process. Program leadership developed strategies to improve HIV testing rates. Strategies included educational materials and on-site support for both clinical staff and patients, attendance at monthly staff meetings to discuss process/procedure, HIV statistics, and identification and removal of barriers as well as inclusion of the HIV test as part of standard STI order set.
Results: Initiatives and continued persistence drove change that resulted in increased HIV testing in the ED by 20% between January 2023-September 2024. Strategies that produced the greatest impact were inclusion of HIV testing in standard STI order set and focused staff education/support from linkage staff to remove barriers. While staff education was a driver to improve HIV testing, improvements to staffing issues, including high turnover rates did not occurred.
Conclusion: Successful HIV testing programs must include continuous quality improvement measures to ensure overall program goals remain as its center focus to reduce incidence of community transmission. Conducting root cause analyses provides a structured process to determine specific reasons for reduced metrics and drive successful change strategies for optimal outcomes. Strategies must evolve as the new barriers present themselves and program staff must continuously review metrics and be flexible to meet new challenges.
Keywords
HIV Testing, Root Cause Analysis, Continuous Quality Improvement
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Utilizing Continuous Quality Improvement Strategies for Improving HIV Screening Rates in a Rural Emergency Department
Background: Memorial Health University Medical Center conducts opt-out HIV screening in its Adult Emergency Department (ED) for ages ≥18. Integrated technology-based algorithms attach HIV tests to lab orders. Consent at triage is documented in the medical record. Post-COVID monthly reports reviewed between January 2019-December 2023 identified a 46% reduction in patients receiving the standardized HIV test. We endeavored to better understand the factors leading to the decline HIV testing and implement improvement strategies.
Methods: Root cause analysis determined specific cause(s) for the lack of adult HIV testing. Identified contributing factors were increased patient volume, low staffing but high staff turnover, and change in registration process. Program leadership developed strategies to improve HIV testing rates. Strategies included educational materials and on-site support for both clinical staff and patients, attendance at monthly staff meetings to discuss process/procedure, HIV statistics, and identification and removal of barriers as well as inclusion of the HIV test as part of standard STI order set.
Results: Initiatives and continued persistence drove change that resulted in increased HIV testing in the ED by 20% between January 2023-September 2024. Strategies that produced the greatest impact were inclusion of HIV testing in standard STI order set and focused staff education/support from linkage staff to remove barriers. While staff education was a driver to improve HIV testing, improvements to staffing issues, including high turnover rates did not occurred.
Conclusion: Successful HIV testing programs must include continuous quality improvement measures to ensure overall program goals remain as its center focus to reduce incidence of community transmission. Conducting root cause analyses provides a structured process to determine specific reasons for reduced metrics and drive successful change strategies for optimal outcomes. Strategies must evolve as the new barriers present themselves and program staff must continuously review metrics and be flexible to meet new challenges.
