Emergency Department, Charing Cross Hospital, London, UK.
Emergency Department, Charing Cross Hospital, London, UK
BMJ Open Qual. 2022 Dec;11(4). doi: 10.1136/bmjoq-2021-001799.
HIV is a global public health issue. Routine testing for HIV should be performed on all 16-59 years old attending emergency departments (EDs) in high-prevalence areas in the UK.In August 2020, Charing Cross Hospital ED, situated in an 'extremely high-prevalence' area, had no formal guidelines on HIV testing. We aimed to increase HIV testing in 16-59 years old attending our ED to 25% by August 2021 through a quality improvement project, based on the Methodology for Improvement Model, performing six Plan-Do-Study-Act cycles over a 12-month period.An initial ED staff survey revealed 55% (n=22/40) of respondents were unsure of national HIV testing guidelines. Barriers to good testing practice included: lack of clarity on protocols for consent and indication, cost and perceived stigmatisation of patient groups. Interventions were employed at regular intervals, including employment of an HIV nurse advocate, inclusion of HIV tests in a blood test careset during ED triage, and updated trust guidelines that reflect national guidelines.Overall, we did achieve our original 12 month aim, with an average testing rate of 28% of our target group between September 2020 and August 2021. Extending the project to January 2022 has resulted in continued improvements in monthly testing rates, reaching 44% in December 2021. Further analysis revealed interventions led to a statistically significant and sustained increase in monthly testing rates on seven occasions.Valuable lessons were learnt in sustaining improvements in a busy department, changing long-held beliefs regarding consent for testing, and education around HIV care in the UK. Project write-up was formatted using the Revised Standards for Quality Improvement Reporting Excellence (SQUIRE) template.
HIV 是一个全球性的公共卫生问题。在英国高流行地区，所有 16-59 岁就诊于急诊科（ED）的人都应进行常规 HIV 检测。2020 年 8 月，位于“极高流行”地区的查令十字医院 ED 没有关于 HIV 检测的正式指南。我们的目标是通过一个质量改进项目，在 2021 年 8 月前将我们 ED 就诊的 16-59 岁人群中 HIV 检测率提高到 25%，该项目基于改进模型方法论，在 12 个月的时间内进行了六次计划-执行-研究-行动循环。一项最初的 ED 工作人员调查显示，55%（n=22/40）的受访者不确定国家 HIV 检测指南。良好检测实践的障碍包括：对同意和指征的协议以及成本和对患者群体的污名化缺乏明确性。我们定期采取干预措施，包括雇佣一名 HIV 护士顾问，在 ED 分诊期间的血液检查套餐中纳入 HIV 检测，以及更新反映国家指南的信托指南。总的来说，我们确实实现了最初的 12 个月目标，在 2020 年 9 月至 2021 年 8 月期间，我们的目标人群中有 28%接受了检测。将项目延长至 2022 年 1 月，导致每月检测率持续提高，2021 年 12 月达到 44%。进一步的分析表明，干预措施导致每月检测率在七次出现了统计学上显著且持续的增加。在一个繁忙的部门中维持改进、改变对检测同意的长期信念以及在英国进行 HIV 护理教育方面，我们都吸取了宝贵的经验。项目报告的编写使用了修订后的质量改进报告卓越标准（SQUIRE）模板。
