Electronic Decision Support Improves HIV Test Offers Among at-Risk Youths Presenting to a Pediatric Emergency Department

Background:  The CDC recommends HIV screening for adolescents and young adults, especially those at high risk. In order to increase HIV testing in our pediatric emergency department (PED) we developed a quality improvement project that resulted in modest increases in HIV test offers, but the process was unreliable.  In order to increase the reliability of testing, we sought to measure the effect of an electronic decision support tool (DST) on HIV testing among at-risk youth presenting to our ED.

Methods:  We conducted a prospective study in a pediatric tertiary care hospital ED focusing on patients that received testing for STIs. A DST was implemented into our EMR in Oct 2012. It is triggered when a provider orders any STI test (including gonorrhea, chlamydia, trichomonas, syphilis), but does not order HIV testing.  It prompts the provider to order appropriate HIV testing or to document the reason for not ordering a test. The DST also displays results of HIV tests in our system in the last 12 months. We then measured the number of documented offers pre and post DST in those that were eligible.

Results:  Data were analyzed six months pre (April – September 2012) and post DST implementation (October 2012 – March 2013). Pre- DST, patients tested for STIs had a documented offer of an HIV test 73% (528/721) of the time. Post-DST, a documented offer of an HIV test increased to 84% (549/651), p < 0.001.

Conclusions:  The implementation of a DST has significantly increased the number of HIV tests being offered to our patient population thus increasing the number of high risk patients being screened.