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HIV, STIs and Viral Hepatitis Routine Screening Emergency Department Toolkit: Testing and diagnosis

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Routine Screening Toolkit: Emergency Department

Step 1: Patient triage | Step 2: Initiating standard screening protocol | Step 3: Testing and diagnosis

Step 4: Patient education and post-test counseling | Step 5: Linkage to Care


A lack of a clear protocol for testing, compounded by an overwhelming demand for care, causes staff roles to blur and leaves the bulk of the workflow on the clinician’s shoulders, including obtaining consent, disclosing results, counseling, and coordinating follow-up care.

Defining a routine testing plan streamlined by EHR support, outlining a clear post-test protocol, and clarifying team member roles can help incorporate routine screening more seamlessly into standard workflows. If it is feasible, having dedicated staff or volunteers to initiate point of care testing, allows clinicians to focus on confirmatory screening, treatment, and the chief reason for the visit.

Additionally, some clinicians and staff also feel intimidated by interpreting results and next steps for the inconclusive test results. For HIV, clinicians are often unaware what the next step is upon a positive diagnosis. Providing education on the latest evidence-based guidance for screening, testing and treatment can instill confidence in the care team and provide a more personal approach to address the patient’s needs.  

Hospital infrastructure limitations can also present challenges that hinder efficiencies when it comes to testing and diagnosis such as not having sufficient capacity in on-site labs for test storage at the scale required for conducting routine screening, including access to, storage of and space to run rapid tests. Additionally, financial constraints can impose limitations on routine screening program such as not having dedicated funds to integrate screening related EHR alerts. Breaking down direct and indirect costs for each element of the routine screening and testing continuum can help identify gaps and potential funding sources to cover related testing costs. Further, understanding how to properly code services for eligible patients will help with reimbursement for the cost of services and help limit unexpected out of pocket costs for the patient.

  • Screening guideline ambiguity and the need for clarity for all test result scenarios and who to notify and when to notify them 
  • Knowing they have the responsibility to check results and make follow-up calls, clinicians are hesitant to screen in addition to urgent clinical duties
  • Education on interpreting results and next steps for inconclusive/indeterminate results
  • Lack of on-site equipment and reliance on external labs thus clinicians are hesitant to order initial test if the patient will need to be referred out to a clinic and pay twice for testing
  • Desire from patients to know results right away is at odds with testing logistics and can lead to loss of contact with the patient before results are complete 
  • Pressure to meet other funder-driven requirements in addition to patient’s chief reason for visit 
  • Knowledge and awareness of the appropriate CPT codes
  • Lack of payer coverage for routine screening for HCV
  • STD tests sometimes run into insurance denials based on diagnostic codes
  1. Streamline the testing cascade 

    1. Optimizing the clinical workflow can help to streamline testing, clarify roles and ensure emergency department staff know what happens at each step along the way. Also, leveraging testing innovations like rapid antibody test technology or Reflex RNA for HCV, which allows for faster detection through the ability to immediately run another lab test on the same blood draw so that patients do not have to return for additional testing, allows for quicker delivery of results to patients. Clear guidance on testing interpretation and result sharing, in accordance with applicable privacy laws, will help reduce the cognitive load for health care professionals who are juggling a positive diagnosis with other immediate clinical needs. Strong relationships with local health departments (in particular, disease surveillance units) can also enable clinical staff members to rapidly identify which patients are experiencing a diagnosis for the first time, or who need reengagement in medical care.
    2. Related resources

  2. Outline funding and reimbursement strategies

    1. Breaking down direct and indirect costs for each element of routine screening and testing, across the health setting’s payer mix, will help identify gaps in funding and reimbursement and uncover opportunities for negotiation. Budgeting EHR development, equipment, the cost of tests, and staff time for routine screenings will eliminate unknowns and inspire confidence. Additionally, ensuring you are coding services properly for eligible patients will ensure you are reimbursed for the cost of the service and that the patient will not have any out-of-pocket costs.
    2. Related resources

Disclaimer: This page contains resources supplied by third party organizations. Inclusion of these materials on this page does not imply endorsement of these resources or corresponding organization.


The toolkit is organized across the screening continuum and offers helpful resources and best practices for the emergency department care team.

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