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Operational Flow: Which patient area?
ED patients have varying levels of acuity, with primary complaints ranging from broken fingers to gunshot wounds. As HIV testing is voluntary, it is important that patients understand and consent to their HIV test. Urgent care (fast track) and observation medicine units (or 23-hour admits) provide practical areas of the ED in which to offer HIV tests to patients.
Urgent care or Fast Track
Urgent care or fast-track areas see a large volume of patients with minor, often nonemergent conditions. They may be located in the ED proper or in a nearby location. They often have their own waiting areas and are staffed by nurses and physician assistants. Urgent-care patients are typically ambulatory and alert—good candidates for HIV testing. However, quick turnover of patients can present a challenge. In some sites, urgent care patients are seen within 30 minutes. When using rapid tests, testing programs can take advantage of multiple opportunities for approaching and testing patients so that patients receive their test results during their visit.
top of this pageED's observation unit
The ED's observation unit houses patients who have been treated and stabilized but will not be admitted. The patients' stay may last a few hours, and they will be discharged within 23 hours of arriving in the ED. A patient's consciousness must be an important consideration in this setting.
top of this pagePresenting Conditions and Histories
When a targeted approach is employed, patients eligible for testing can be identified on the basis of self-reporting, social and medical history, and/or medical evaluation.
Historical Characteristics
Men who have sex with men (MSM)
Heterosexual with multiple partners
Exchange of sex for drugs or money
Injection-drug use
History of sexually transmitted disease
Unprotected sex with a partner who is HIV-infected or has risk factors for HIV
Homeless
Clinical Characteristics
Sexually transmitted diseases
Abdominal pain and vaginal discharge and/or dysuria in women
Testicular pain, dysuria, and/or discharge in men
Pneumonia
Tuberculosis
Severe gingivitis or peridonitis
Persistent oral candidiasis (thrush)
Unexplained chronic diarrhea (greater than one month)
Persistent fevers
Unexplained severe weight loss
Unexplained anemia, neutropenia, or thrombocytopenia (low blood platelets)
Persistent generalized lymphadenopathy (swollen lymph nodes)
Recurrent respiratory tract infections
Recurrent oral ulceration, herpes zoster, Bell's palsy, and a variety of dermatologic conditions
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