256 A Descriptive Analysis of Patients Who Opt Out of Routine HIV Screening in the Emergency Department

Abstract

The BPA Sepsis Risk Scoring System was created based on the SSC guidelines and guided by the Detecting and Treating Sepsis manual from Epic Systems. A score >2.5 meant that a patient met SIRS criteria, is potentially septic, and triggered the BPA. The definitive diagnosis of sepsis for ED SIRS visits was based upon final diagnostic related group (DRG) coding and further established by imaging modalities, urinalysis, and physical exam findings on chart review. BPAs' sensitivity, specificity, PPV, NPV was calculated and 95% confidence intervals (CI) established.Results: Over the course of the study period, 13,906 records were screened, 565 BPAs fired and 313 cases of sepsis were confirmed (2.3% prevalence). The BPAs' sensitivity and specificity was 74.5% (95% CI 69.2-79.1%) and 97.6% (95% CI 97.3-97.8%) respectively, with positive and negative predictive values of 41.2% (95% CI 37.2-45.4%) and 99.4% (95% CI 99.3-99.5%) respectively. The BPA's positive and negative likelihood ratios (LR) (weighted for prevalence) were 0.70 (95% CI 0.62-0.79) and 0.006 (95% CI 0.005-0.008). No significant changes were noted in the BPA sensitivity or specificity when confined to severe sepsis or septic shock.Conclusion: BPAs were an effective EHR-based tool that detected potentially septic patients with moderate sensitivity and high specificity in our ED. The test's high negative LR and negative predictive value make it valuable in excluding sepsis as differential diagnosis in a general ED population. Future directions for follow-up studies include cost analysis, morbidity/mortality studies, and multicenter comparisons of other quality metrics that can be improved by having a system such as BPA that reduces time to appropriate medical intervention.

A comprehensive theoretical framework for the implementation and evaluation of opt‐out HIV testing

“…Research evaluating opt‐out HIV testing has found that it has a positive impact on health outcomes and is generally acceptable to both patients and health care providers across a variety of health care settings . However, researchers have also reported barriers to full implementation, such as ethical concerns among staff performing HIV testing , patients perceiving themselves to not be at risk , and provider discomfort with testing and giving results . A theory‐based strategy could be useful in addressing these barriers.…”