offer and order a serum-based HIV test at the time of initial patient screening ... from the hospital electronic medical record (EMR) for all patients triaged in the.
Research Forum Abstracts for IT issues. We compared differences in non-opioid prescriptions of ED providers (attendings, MLPs, and EM residents) for a 6-month time frame pre and post guidelines in 2012 and 2013. Results: Over the same period where both percentages and absolute number of opioid pills and prescriptions decreased markedly, there was a significant increase in non-opioid analgesic prescriptions, although not matching the level of opioid decrease. The total number of non-opioid prescriptions (excluding tramadol) increased by 5.7 %. Acetaminophen and NSAIDS (in aggregate) increased by 5.3 %, muscle relaxants increased by 8.2% and tramadol decreased by 9.6%. The absolute number of non-opioid analgesics pills prescribed increased by 40,608 (1.3%), with an increase of 32,846 (+1.2%) in acetaminophen and NSAIDS and an increase of 22,624 (10.1%) of muscle relaxants. There was a decrease of 14,862 (-30.3%) of tramadol. Conclusion: There was a large and clinically important increase in all non-opioid pain relievers in a large public hospital system after the introduction of opioid prescribing guidelines.
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A Comparison of Routine HIV Screening Strategies in a Large, Inner-City Emergency Department: Integrated versus Parallel Models
Hankin A, Freiman H, Copeland B, Shah B/Emory University, Atlanta, GA
Study Objectives: Emergency departments (EDs) are important sites for routine HIV screening. The incidence of undiagnosed HIV among urban ED patients is estimated at 1-5%. We compared two approaches for implementation of routine HIV screening in the ED: 1) designated HIV counselors working in parallel with the ED medical care processes and 2) nurse-initiated testing integrated into the ED triage process. Methods: A retrospective cohort analysis comparing a parallel-testing approach using designated HIV counselors and oral rapid HIV testing technology (2008 to 2011) to an integrated testing approach, in which ED nurses offer and order a serum-based HIV test at the time of initial patient screening (July 2013 to present). Both programs utilized opt-out consent. Parallel-testing data were extracted from de-identified records collected at the time of patient consent and pre-/post-test counseling. Integrated testing data were extracted from the hospital electronic medical record (EMR) for all patients triaged in the ED since initiation of integrated testing, including patient demographics, number of HIV tests offered and performed, and test results. Accuracy of EMR data were confirmed via chart review (randomly chosen subsample of patient charts). A Z-test between two proportions was performed to compare HIV testing rates and test results. Results: During the first 8 months of the parallel testing, there were approximately 80,000 ED visits, with 1,879 HIV tests administered and 33 newly identified HIV infections. During 8 months of integrated testing, 73,456 patients were triaged and 44% were eligible for test offer (97% of eligible patients were offered a test). Of patients offered a test, 68% did not opt-out, with 9,822 unique patients tested and 128 (1.30%) new HIV diagnoses. Integrated screening resulted in an increased rate of HIV testing compared to parallel screening (0.14 tests/ED patient visits versus 0.02 tests/ED patient visits, P
