Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio (Drs Lane, Lyons, and Punches and Ms Ancona); and University of Cincinnati College of Nursing, Cincinnati, Ohio (Punches).
Adv Emerg Nurs J. 2021;43(2):138-144. doi: 10.1097/TME.0000000000000349.
Emergency departments (EDs) are an important potential site for public health screening programs, although implementation of such programs can be challenging. Potential barriers include system-level issues (e.g., funding and time pressures) and individual provider-level issues (e.g., awareness and acceptance). This cross-sectional evaluation of a nurse-driven, triage-based hepatitis C virus (HCV) screening program in an urban, academic ED assessed variation in nurse participation from April to November 2017. For this program, electronic health record (EHR) prompts for HCV screening were integrated into nurses' triage workflow. Process measures evaluating HCV screening participation were abstracted from the EHR for all ED encounters with patient year of birth between 1945 and 1965. Registered nurses who routinely worked in triage and were full-time employees throughout the study period were included for analysis. The primary outcome was the proportion of eligible ED encounters with completed HCV screening, by nurse. Of 14,375 ED encounters, 3,375 (23.5%, 95% confidence interval [CI]: 22.8, 24.2) had completed HCV screening and 1,408 (9.8%, 95% CI: 3.9, 10.3) had HCV screening EHR sections opened by the triage nurse but closed without action; the remainder of encounters had no activity in HCV screening EHR sections. Among the 93 eligible nurses, 22 nurses (24%, 95% CI: 16, 34) completed HCV screening for more than 70% of encounters, whereas 10 nurses (11%, 95% CI: 6, 19) never completed HCV screening. The proportion of eligible encounters with completed HCV screening was 11.0% higher (95% CI: 9.8, 12.6) for encounters seen between 7 a.m. and 7 p.m. than between 7 p.m. and 7 a.m. (27.5% and 16.3%, respectively). In conclusion, wide variation in individual nurse participation in HCV screening suggests individual-level barriers are a more significant barrier to ED screening than previously recognized. Implementation research should expand beyond questions of resource availability and procedural streamlining to evaluate and address staff knowledge, beliefs, attitudes, and motivation.
急诊科是公共卫生筛查项目的一个重要潜在场所，尽管实施此类项目可能具有挑战性。潜在的障碍包括系统层面的问题（例如，资金和时间压力）和个体提供者层面的问题（例如，意识和接受程度）。本项针对一项在城市学术急诊科中由护士主导、基于分诊的丙型肝炎病毒（HCV）筛查项目的横断面评估，评估了 2017 年 4 月至 11 月期间护士参与情况的变化。对于该项目，电子健康记录（EHR）中 HCV 筛查的提示被整合到护士的分诊工作流程中。从出生年份在 1945 年至 1965 年之间的所有 ED 就诊记录中提取了评估 HCV 筛查参与度的过程指标。被纳入分析的是经常在分诊工作且在整个研究期间为全职员工的注册护士。主要结局是由护士完成的合格 ED 就诊中完成 HCV 筛查的比例。在 14375 次 ED 就诊中，3375 次（23.5%，95%置信区间[CI]：22.8，24.2）完成了 HCV 筛查，1408 次（9.8%，95%CI：3.9，10.3）由分诊护士打开了 HCV 筛查 EHR 部分但未采取行动而关闭；其余就诊没有 HCV 筛查 EHR 部分的活动。在 93 名合格护士中，22 名护士（24%，95%CI：16，34）为超过 70%的就诊完成了 HCV 筛查，而 10 名护士（11%，95%CI：6，19）从未完成 HCV 筛查。上午 7 点至下午 7 点之间就诊的合格就诊中完成 HCV 筛查的比例比下午 7 点至上午 7 点之间就诊的比例高 11.0%（95%CI：9.8，12.6）（分别为 27.5%和 16.3%）。总之，个别护士参与 HCV 筛查的差异很大，表明与先前认识相比，个体层面的障碍是 ED 筛查的一个更大障碍。实施研究不应仅局限于资源可用性和程序简化问题，而应评估和解决员工的知识、信念、态度和动机问题。
