Implementing Indicator Condition–Guided HIV Screening Alerts in the Emergency Department: Lessons Learned from a Case Study.
Introduction: Indicator condition (IC)-guided HIV testing is recommended internationally as a cost-effective strategy but remains inconsistently implemented, particularly in emergency departments (EDs). Electronic health record (EHR) alerts may improve adherence; however, real-world uptake depends o...
| Publicado en: | Inquiry (00469580) Vol. 63; pp. 1 - 8 |
|---|---|
| Autores principales: | , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Sage Publications Inc.
7/24/2026
|
| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=hlh&AN=195627715&site=ehost-live header: @attributes: shortDbName: hlh uiTerm: 195627715 longDbName: Humanities International Complete uiTag: AN controlInfo: bkinfo: jinfo: jid: 00469580 INQ jtl: Inquiry (00469580) issn: 00469580 maglogo: Y pubinfo: dt: 7/24/2026 vid: 63 pid: 344 pub: Sage Publications Inc. artinfo: ui: 195627715 10.1177/00469580261468834 ppf: 1 ppct: 7 formats: tig: atl: Implementing Indicator Condition–Guided HIV Screening Alerts in the Emergency Department: Lessons Learned from a Case Study. aug: au: Fanjul, Francisco Macià Romero, Maria Dolores Fraile, Pablo Guiu, Alexandra Campins, Antoni Ferré, Adrià Pinecki, Sophia Riera, Melchor affil: Infectious Diseases Unit, Son Espases University Hospital, Palma, Spain Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain Faculty of Medicine, University of the Balearic Islands, Palma, Spain Microbiology Department, Son Espases University Hospital, Palma, Spain Emergency Department, Son Espases University Hospital, Palma, Spain su: Diagnosis of HIV infections Patient compliance Effect sizes (Statistics) Research funding Clinical decision support systems Hospital emergency services HIV infections Descriptive statistics Chi-squared test Longitudinal method Odds ratio Electronic health records Medical screening Case studies Quality assurance Confidence intervals sug: subj: Diagnosis of HIV infections Patient compliance Effect sizes (Statistics) Research funding Clinical decision support systems Hospital emergency services HIV infections Descriptive statistics Chi-squared test Longitudinal method Odds ratio Electronic health records Medical screening Case studies Quality assurance Confidence intervals keyword: decision support systems clinical emergency service hospital HIV implementation science indicator conditions quality improvement ab: Introduction: Indicator condition (IC)-guided HIV testing is recommended internationally as a cost-effective strategy but remains inconsistently implemented, particularly in emergency departments (EDs). Electronic health record (EHR) alerts may improve adherence; however, real-world uptake depends on organizational and specialty-level determinants. Methods: Prospective case study conducted between August 2023 and April 2025. A non-interruptive EHR alert was triggered by predefined IC-related laboratory orders and antimicrobial prescriptions. Crucially, the alert was only fired if HIV serology was not already requested, meaning that the accepted tests represented true additional screening. Clinicians could accept or decline testing with a single click. Acceptance patterns were analyzed by age group, clinical service, weekday versus weekend, and diurnal versus nocturnal shifts. The analysis employed descriptive stratification to evaluate confounding between patient age and clinical service volume. Results: Among 3,240 alert activations, 523 were accepted (16.1%), resulting in 398 completed tests. Eight patients tested positive (2.01%), including four actionable cases (1.01%). Two declined alerts were followed by subsequent diagnoses of advanced HIV infection. The apparent lower uptake in younger patients was service-level confounded by the concentration of alerts within gynecology/obstetrics (53.7% of all alerts in 18-37-year-olds; global gynecology uptake 3.5%). Outside gynecology, baseline acceptance was consistently higher (15-38%) across all age categories, demonstrating that the apparent age gradient was profoundly confounded by service distribution. Conclusion: Apparent age-related differences in alert uptake were attenuated after stratification by service distribution rather than intrinsic clinician bias regarding patient age. Specialty culture, workflow alignment, and ownership of preventive tasks appear to be central to the adoption of digital alerts in ED settings. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: Y dt: @attributes: year: 2026 holdings: @attributes: islocal: N |
|---|