Background: As of April 2020, the Center for Disease Control and Prevention recommends one-time Hepatitis C testing for all adults age 18 and over and all pregnant women during every pregnancy. Previous research shows that Emergency Departments (ED) are effective settings for screening and diagnosing individuals for Hepatitis C Virus (HCV). The purpose of this study is to compare the effectiveness of opt-out versus automated HCV screening in an ED setting.
Methods: Jersey City Medical Center (JCMC) implemented non-targeted opt-out screening to its ED in February 2019. This approach required an additional step dependent upon the ED nursing staff to document whether the patient opted out of HCV screening in the patients’ electronic medical record (EMR). If the patient did not opt-out, HCV antibody (Ab) with reflex to confirmatory RNA tests were added to the patients’ blood work orders. On June 9 2020, JCMC automated HCV screening for eligible patients. If eligible, when a physician orders blood work, HCV AB with reflex to RNA is automatically added to the order. This is a retrospective study comparing HCV screening data 30 days before (May 10-June 8, 2020) and after full automation (June 10-July 9, 2020).
Results: Thirty days before automation, JCMC averaged 10.4 HCV screenings per day for a total of 555 screenings. After full automation, JCMC averaged 69.7 screenings per day for a total of 3,699 screenings in 30 days. This is a 566% increase in total screening volume within 30 days. Results from an unpaired t-test showed a statistically significant difference between daily testing volume before and after automation (t (29) = -24.4; p-value: <.00001). Before automation JCMC identified 20 patients HCV Ab reactive with 8 viral load positive and after automation JCMC identified 71 HCV Ab reactive and 31 viral load positive.
Conclusions: A non-targeted, automated screening approach utilizing EMR automation at JCMC was an effective method to screen and identify more people needing linkage to a HCV specialist which is essential for slowing further transmission of HCV.