Key Players: Emergency Department

• Leadership
• Clinical Staff
• Registration and Triage

Leadership

Emergency department leaders are the clinical and administrative directors of the ED. These include medical chiefs, formal and informal physician and nurse leaders, administrative directors, and residency and fellowship directors. ED leaders can create a supportive environment for HIV testing. They can champion the effort among hospital administrators and ED staff. They can elicit buy-in among staff who would be responsible for the program and help secure human resources to oversee and execute the program.  ED leaders, particularly in high-prevalence settings, have acknowledged that knowing a patient's HIV status can promote accurate diagnosis and treatment of patients in the ED. These leaders are concerned with  increased burden on their staff and the disruption of service flow in the ED. Piloting HIV testing on a small scale will help demonstrate the likely effect (or lack thereof) of HIV testing on ED operations.

Clinical Staff

Clinical staff could perform some or all aspects of HIV testing. While many would favor knowing their patients' HIV status, in practice, they might give HIV testing low priority because of the patient's presenting condition and history or because they are simply too busy. Clinical staff may be concerned about the time required for informed consent and counseling, especially when the ED is overburdened and understaffed. They might more readily support a parallel, nonintrusive testing service in the ED rather than incorporating testing into routine care.

Registration and Triage

These staff can be the patients' first point-of-contact for HIV testing in the ED by providing information, offering the test to patients, or taking specimens in triage. Registration and triage staff can be an integral component of the program when the goal is universal testing. They can build awareness and create the expectation among patients that they can get tested and get their results. Of course, registration and triage can be chaotic environments. Additional responsibilities for HIV testing may be perceived as an increased burden on staff. See Operational Flow for more information on how to use registration and triage staff.

<< Prev Page  |  Next Page >>

Who is your champion in the ED?

Every program needs a champion to get it off the ground. The champion will use her or his influence and resources to:

• Call the array of stakeholders into action
• Build political will and rally support to respond to emerging issues
• Promote to internal and external audiences an understanding of the program, its importance, and goals, and
• Bring legitimacy to the effort.

An ED-based program needs a champion in the ED. Ideally, this is a chief or attending physician or nurse leader who is influential among the administrative ranks and with front-line staff. The champion becomes the face associated with the program to external audiences such as foundations, other hospitals, and the media, so must be comfortable in that role. The champion does not need to be the long-term project director.