Eric J. Moore

Using a configurable EMR and decision support tools to promote process integration for routine HIV screening in the emergency department

Given the clinical and public health benefits of routine Human Immunodeficiency Virus (HIV) testing in the emergency department (ED) and Centers for Disease Control and Prevention recommendations, Maricopa Medical Center, as part of Maricopa Integrated Health System, started Test, Educate, Support, and Treat Arizona (TESTAZ) and became the first and, to-date, only hospital in Arizona to implement routine, non-targeted, opt-out, rapid HIV screening in the ED. The authors describe the implementation of a universal, routine, opt-out HIV screening program in the adult ED of an urban safety-net hospital serving under-served populations, including the uninsured and under-insured. Through a controlled and collaborative process, the authors integrated custom documentation elements specific to HIV screening into the triage/intake process, implemented and utilized clinical decision support tools to guide clinicians in each step of the process, and used electronic data collection and reporting to drive new screening protocols that led to a significant increase in overall HIV testing rates.

The Journey Toward Routinization: Triage Nursing and the Success of an Emergency Department–Based Routine HIV Testing Program

outinization contains 2 intrinsic ideas. The first idea is that of routinization as journey. It is a process by estimates that worldwide, in 2014, 36.9 million people were Rwhich activities are introduced so as to follow regular or unchanging patterns. The journey is complex and challenging. The second idea is that of routinization as destination. It is the institutionalization of activities that improve the quality of health care. The destination empowers nursing staff, especially during triage, to make decisions that help patients and improve the overall health of the community. In this article we describe the routinization journey undertaken and the routinization destination attained by Maricopa Integrated Health System (MIHS) when routine, opt-out human immunodeficiency virus (HIV) screening was introduced into the adult emergency department.