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Date of Report:
01/2007
Source:
Pennsylvania/MidAtlantic AETC
Beginning in fall 2006, the Southeast AETC (SEATEC) is partnering with the Rollins School of Public Health as well as the Departments of Medicine and Emergency Medicine at Emory University School of Medicine to initiate routine HIV testing in the Emergency Department (ED) at Grady Health Systems in downtown Atlanta, Georgia. The anticipated yield of new HIV diagnoses is in the range of five cases a day.
Under the direction of Jane Fox, MPH, SEATEC has collaborated with a team of three public health graduate students to administer a training needs assessment survey of attending physicians, nurses, housestaff and midlevel clinicians at the Grady Health Systems ED and at two additional Atlanta hospitals linked to the Emory University School of Medicine. One-hundred and three questionnaires were returned, with 34 percent from attending physicians, 17 percent from housestaff, and 49 percent from midlevel clinicians and nurses.
Key training needs assessment findings were:
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Clinical case discussion and lecture are the preferred educational methodologies. |
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Rapid testing, postexposure prophylaxis, and Georgia law pertaining to HIV are the training topics of greatest interest. |
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Almost a third of respondents expressed interest in a Level III HIV preceptorship. |
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At present, little HIV testing happens in EDs. Some 65 percent of respondents do not offer testing at all; 13.6 percent offer testing only upon patient request; 8.7 percent offer it when another sexually transmitted disease is present; and 6.8 percent offer it based on clinical findings. |
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A major reported barrier to offering HIV testing is concern about managing follow-up for patients who test positive (79.6%). Planning for |
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Planning for Start-Up
SEATEC currently participates in planning sessions with key decision-makers from both the Departments of Medicine and Emergency Medicine to share the needs assessment findings and listen for issues that can be addressed in future trainings. Meanwhile, HIV skill-building has been addressed in two weekly Level I and II ED Rounds in December, addressing common antiretroviral side effects and complications as well as other HIV medical issues likely to bring patients into the ED.
Once the key decision-makers have worked out policies and protocols for routine rapid testing and for management of positive patients, SEATEC will launch an intensive training series for all ED staff, addressing the issue of opt-out testing, protecting privacy, conveying test results, and followup care for patients who test positive.
SEATEC will assess the efficacy of training by collecting data on changes in knowledge, attitudes, and - most importantly - testing the practice of these clinical care providers. By late summer, SEATEC plans to train new housestaff and others joining the ED staff.
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