Routine HIV Testing in an Acute Medical Setting
Routine HIV Testing in an Acute Medical Setting
The acute medical unit (AMU) is where patients are assessed prior to admission to specialised wards. A routine opt-out HIV testing policy commenced at Croydon University Hospital, a district general hospital, in July 2011 whereby all patients aged 16–79 years attending the AMU were to have a standard HIV test unless they declined. The assay was funded by a public health budget commissioned as a result of a business case presented to the local Healthcare Commissioning Board. The testing pathway was agreed at a joint meeting attended by senior representatives of AMU, microbiology and HIV departments.
Prior to roll-out, AMU staff were trained by the HIV team at workshops, which focused on offering the test. Similar tutorials were presented to medical trainees; these were subsequently repeated at inductions. Prelaunch publicity comprised posters in the AMU and postgraduate centre, emails to all medical doctors, announcements at grand rounds (medical teaching events) and articles on the Trust intranet. The AMU pro-forma was adapted to allow staff to document prospectively test offer, acceptance and reasons if declined. These data were matched with patient demographics and test results obtained from the medical notes and pathology records, respectively.
Following arrival to the AMU, patients were given a welcome pack, which included information on the HIV testing policy. General medical doctors or nurses from AMU obtained verbal consent for the test, after which an electronic order was made followed by phlebotomy, rather than an HIV request being added to a previously taken serum sample. If the patient had had an HIV test in the previous 12 months the sample was not processed, unless the requester stated a clear reason for repeat testing. Patients were informed that results would be communicated on a 'No news is good news' basis. Positive results were communicated from the laboratory to the admitting team.
The HIV team offered support to the medical team in giving the initial reactive HIV test result. On confirmation of the patient's seropositive status, specialist follow-up was arranged, ensuring a seamless link into HIV care. For cases where the patient left the hospital before the initial HIV test was reported, a general medical outpatient appointment was arranged, where the result was given prior to continuing care by the HIV team.
HIV team members of all grades visited AMU every weekday to encourage staff to offer the test and to troubleshoot any problems. From the outset, nurses were more proactive than doctors in applying the policy. Building on their enthusiasm, nurses were encouraged further. By October 2011, AMU visits were withdrawn gradually as nurses took the lead to enforce the policy. A retrospective cross-sectional review was conducted. Testing rate and outcomes of those testing HIV seropositive were determined by review of hospital data systems and case notes.
Methods
The acute medical unit (AMU) is where patients are assessed prior to admission to specialised wards. A routine opt-out HIV testing policy commenced at Croydon University Hospital, a district general hospital, in July 2011 whereby all patients aged 16–79 years attending the AMU were to have a standard HIV test unless they declined. The assay was funded by a public health budget commissioned as a result of a business case presented to the local Healthcare Commissioning Board. The testing pathway was agreed at a joint meeting attended by senior representatives of AMU, microbiology and HIV departments.
Prior to roll-out, AMU staff were trained by the HIV team at workshops, which focused on offering the test. Similar tutorials were presented to medical trainees; these were subsequently repeated at inductions. Prelaunch publicity comprised posters in the AMU and postgraduate centre, emails to all medical doctors, announcements at grand rounds (medical teaching events) and articles on the Trust intranet. The AMU pro-forma was adapted to allow staff to document prospectively test offer, acceptance and reasons if declined. These data were matched with patient demographics and test results obtained from the medical notes and pathology records, respectively.
Following arrival to the AMU, patients were given a welcome pack, which included information on the HIV testing policy. General medical doctors or nurses from AMU obtained verbal consent for the test, after which an electronic order was made followed by phlebotomy, rather than an HIV request being added to a previously taken serum sample. If the patient had had an HIV test in the previous 12 months the sample was not processed, unless the requester stated a clear reason for repeat testing. Patients were informed that results would be communicated on a 'No news is good news' basis. Positive results were communicated from the laboratory to the admitting team.
The HIV team offered support to the medical team in giving the initial reactive HIV test result. On confirmation of the patient's seropositive status, specialist follow-up was arranged, ensuring a seamless link into HIV care. For cases where the patient left the hospital before the initial HIV test was reported, a general medical outpatient appointment was arranged, where the result was given prior to continuing care by the HIV team.
HIV team members of all grades visited AMU every weekday to encourage staff to offer the test and to troubleshoot any problems. From the outset, nurses were more proactive than doctors in applying the policy. Building on their enthusiasm, nurses were encouraged further. By October 2011, AMU visits were withdrawn gradually as nurses took the lead to enforce the policy. A retrospective cross-sectional review was conducted. Testing rate and outcomes of those testing HIV seropositive were determined by review of hospital data systems and case notes.
