RESUMEN
The CDC released revised HIV testing guidelines in 2006 recommending routine, opt-out HIV testing in acute care settings including emergency departments (ED). Patient attitudes have been cited as a barrier to implementation of routine HIV testing in the ED. We assessed patients' perceptions of HIV testing in the ED through a contextual qualitative approach. The study was conducted during a 72-h period. All adults presenting to the ED without life-threatening trauma or psychiatric crisis completed a standardized questionnaire. The questionnaire explored HIV testing history, knowledge of testing resources, and qualitative items addressing participant perceptions about advantages and disadvantages to ED testing. After completion of the interview, participants were offered a free, confidential, rapid HIV test. Among 329 eligible individuals approached, 288 (87.5%) completed the initial interview. Participants overwhelmingly (n=247, 85.8%) reported support for testing and identified increased knowledge (41%), prevention (12.5%), convenience (11.8%), and treatment (4.9%) among the advantages. Fear and denial about one's HIV status, reported by <5% of patients, were identified as the most significant barriers to ED testing. Bivariate analysis determined race and ethnicity differences between individuals completing the interview and those who refused (p<0.05). Among individuals consenting for testing (n=186, 64.6%), no positives were detected. Most patients support HIV testing in the ED, noting knowledge of status, prevention, convenience, and linkage to early treatment as distinct advantages. These data are of particular benefit to decision makers considering the addition of routine HIV testing in EDs.
Asunto(s)
Serodiagnóstico del SIDA/métodos , Comunicación , Servicio de Urgencia en Hospital , Tamizaje Masivo , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Ansiedad/epidemiología , Ansiedad/etiología , Femenino , Humanos , Conducta en la Búsqueda de Información , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/psicología , Tamizaje Masivo/tendencias , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Guías de Práctica Clínica como Asunto , Percepción Social , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
BACKGROUND: Delayed discharge is a costly phenomenon that takes place in every hospital system in the country, with significant operational consequences. The purpose of this study was to identify reasons for delayed discharge and evaluate the financial implications at a Level I trauma center. METHODS: Patients admitted to a Level I trauma center from September 2001 through June 2003 were classified with respect to those who did and did not experience a delay in discharge. RESULTS: For every 25 patients admitted to the trauma center, 1 experienced a delay in discharge, with an average delay of 6 days. The majority of the delays in discharge were attributable to difficulties in patient placement, such as lack of a rehabilitation or subacute hospital bed. Total hospital charges for excess days in the hospital for patients experiencing a delay in discharge were $2,455,703 per year and total costs were $715,403 per year. Patients with delayed discharge tended to be older, female, more severely injured, and more likely to have government-sponsored insurance. CONCLUSION: This study suggests that the main cause of delayed discharge from trauma centers is a consequence of limitations in posthospital care. Strategies must be identified to reduce the barriers to posthospital care to reduce these delays in discharge, lower unnecessary hospital costs, and ensure the financial viability of trauma centers and continuation of clinical services to the communities they serve.