Background: In January 2023, our rural Emergency Department (ED) launched a public health screening program to identify untreated HIV, hepatitis C virus (HCV), and syphilis infections. We developed a nurse-driven Best Practice Advisory (BPA) alert in the electronic health record (EHR) and an orderset for physician use. When initial screening rates were below target, preliminary investigation revealed staff reluctance to adopt a new program and issues with the BPA’s user experience. We questioned “Are screening rates lower than expected due to staff resistance, faulty EHR integration, or both?”
Methods: We implemented technological (modifications addressing BPA functionality) and interpersonal (RN and physician education campaigns) interventions to improve program performance. Testing performance was measured from program launch in January 2023 to May 2024 using EHR-generated reports on BPA and orderset activity. Variables include number of patients meeting testing criteria, number of eligible patients tested, and number of physician-lead tests ordered.
Results: After BPA modifications, the number of monthly tests ordered increased from 201 to 255 (26.6%) for 2.5 months before plateauing. Following each of four RN education campaigns, testing increased 54% on average. While this result gradually declined over an average of six weeks, the new baseline was consistently higher after each campaign, producing an overall upward trend in tests ordered. After a single refresher presentation to physicians, the monthly orderset utilization increased from 3.3 to 8.5 (156.2%).
Conclusion: Each technological and interpersonal intervention improved screening rates for some amount of time. Recurrent engagement with nurses –via regular education, sharing patient success stories, and emphasizing the positive impact of the screening program–resulted in the largest sustained increases in testing rates. However, these interventions impacted each other and all were necessary for increased testing rates. Ongoing interventions are critical to maintaining an effective routine screening program.
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