Hepatitis C Screening and Linkage to Care in an Urban Emergency Department
Background: Hepatitis C virus (HCV) is a major cause of chronic liver disease and is the most common chronic bloodborne pathogen in the United States. The Emergency Department (ED) is potentially a high-yield site in healthcare to reach patients at risk for HCV infection. If the current rates of identification remain constant, it is estimated the HCV-related morbidity and mortality will quadruple over the next decade. The present study aims to determine the effectiveness of an automated ED-based HCV testing and HCV linkage-to-care model, evaluate the Best Practice Advisory (BPA) utilization and increase screening rates of HCV. Methods: An automated HCV screening protocol was implemented into the electronic medical record (EMR) at Henry Ford Hospital. This system screens patients born from 1945 through 1965 and/or those with a history of intravenous drug use, two identified risk factors for HCV. A best practice advisory (BPA) notifies providers to order an HCV antibody (Ab) test for patients with an ordered complete blood count (CBC) and have at least one risk factor. If the HCV Ab test is positive, the provider is prompted to order an HCV ribonucleic acid (RNA) test. Team members follow up with patients until they attend their first visit with Henry Ford Hospital Hepatology Clinic. Data was collected for the first five months before and five months after the implementation (March 2018 through December 2018). Results: In the first five months before the automated screening program was implemented, only 360 HCV Ab tests were performed and only 5.8% were positive. Approximately 72 HCV Ab tests were performed each month. A total of 4 patients received the HCV RNA test and 3 were connected to care. In the five months after implementation, 4,075 HCV Ab tests were performed, 10.4% resulting positive. An average of 815 HCV Ab tests were performed per month (an increase of more than 11-fold). A total of 215 patients received RNA testing and 63 RNA positive patients were connected to care. Conclusion: An automated HCV testing system can be successfully implemented in an ED setting. Additionally, this model places the responsibility of patient follow-up onto non-clinical staff and can be employed in diverse medical settings. These protocols not only can potentially prevent one of the major causes of chronic liver disease and cirrhosis in the U.S. but could also prove effective to screen and test for other infectious diseases.
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