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

6 MIN READ
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


Identifying who to screen for what infection(s) and when is a critical consideration for how to implement an effective routine screening and STI screenings program. Emergency departments continue to face challenges with individual biases about sexual health and infectious disease, both from patients and the clinical staff. This sense of vulnerability, compounded by socialized stereotypes and stigma, makes testing consent conversations emotional and complex. Implementing an opt-out approach to screening can help simplify these conversations and normalize screening as a standard of care.

Guidance from the EHR, including automated orders and reminders, as well as straightforward, demographic-based routine screening criterion have proven to be effective tools for increasing screening and are time and energy savers for a busy care team. Patients feel more comfortable if routine screening is offered as a clinical standard of care, and they feel seen and heard by health care professionals. 

  • The more complex the criteria, the harder it is to reliably execute routine screening
  • Screening conversations can take time while moving through the EHR, making the interaction less personal and more transactional 
  • Implicit bias carried by care team staff members 
  • Lack of EHR support and optimized structure for routine screening 
  • Relying on clinicians to remember to screen for all diseases without alerts or reminders 
  • Testing is seen as a financial liability, at odds with the emergency department’s business model
  • Time constraint of patient encounters
  1. Implement the “opt-out” approach

    1. Training health care professionals and appropriate staff to implement opt-out language helps normalize routine screening as standard of care. Opt-out screening reduces the subjectivity of the decision on behalf of the patient where consent is not legally required. 
    2. Related resources

  2. Stick to sex-positive, status-neutral messaging 

    1. Equipping care team members with training and resources on sex-positive, status-neutral and non-judgmental messaging about risk, transmission, treatment, outcomes, and benefits of screening can help overcome initial patient refusal. 
    2. Related resources

    3. Care team resources to help health care providers educate patients on the importance of sexual health: These tools from the National Coalition for Sexual Health can help health care providers and clinical staff cultivate a clinical environment that delivers inclusive, patient-centered, and accessible sexual health services for all patients.

    4. CDC’s status-neutral approach to prevention and care: This webpage from the CDC provides resources about how routine screening benefits your patients as well as outlines the CDC’s status-neutral approach to prevention and care which ensures that all patients can benefit from quality HIV prevention and care, regardless of their HIV status.
    5. Care team training on LGBTQ, transgender and gender nonconforming essentials: The AMA Ed Hub offers a series of training modules developed by Howard Brown Health, SAGECare, The Fenway Institute and more that can help provide education to your care team on sex-positive and gender appropriate language and methods to incorporate best practices into your organization.
  3. Implement automated EHR reminders, prompts and orders to increase screening 

    1. There is evidence to support that EHR reminders, prompts and orders are effective tools for increasing screening for HIV when compared with no intervention. Based on a systemic review of evidence, the Community Preventative Services Task Force (CPSTF) recommends the use of clinical decision support systems to increase HIV screening for both the general population and for people at higher risk for HIV infection. Tools that need to be standardized include automated risk assessment, automated prompt reminders to initiate screening, clear and specific order sets, hard stop alerts and subsequent pop-ups.
    2. EHRs that automatically flag patients in need of screening as well as EHR reminders to initiate screening takes the pressure off the health care professional to remember who to screen. Alerts can automatically prepopulate test orders, further reducing the clinician’s responsibilities. Auto-orders in the EHR that are connected to the patient identification algorithms for routine screening will reduce time in the EHR and additional steps for clinicians. Positive and indeterminant results can also be linked to auto-orders for confirmatory testing.
    3. Related resources

  4. Align infectious disease control with organization’s goals

    1. Presenting the cost-benefit analysis of catching diseases early versus treating disease progression can help establish infectious disease control as a strategic imperative in a health setting and gain access to timesaving resources.
    2. Related resources

    • CDC’s HIV Cost-effectiveness resource: This resource from the CDC provides a basic guide to the cost-effectiveness analysis of prevention interventions for HIV infection and AIDS and help prevention program staff and planners become more familiar with potential uses of economic evaluation.

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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