Using Electronic Medical Record Flags to Reconnect Patients Lost to Follow-Up in Hepatitis C Virus Screening Program

Document Type

Conference Proceeding

Publication Date

4-20-2023

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: A significant challenge of implementing robust, public health screening programs in the emergency department (ED) is ensuring linkage to care (LTC) for patients that screen positive after discharge from the ED. Collaboration with local and state health departments can optimize resource utilization for Hepatitis C virus (HCV) screening and LTC. Our primary objective was to implement an automated electronic medical record (EMR) flag to increase LTC for patients initially lost to follow-up (LTF) during routine HCV screening. Methods: As part of a clinical quality improvement project in a large, urban ED, we screen patients for HCV using an automated process. This process generates a weekly report of test results. Our research team then works with our local and state health departments to contact patients with positive results to link them to care. When 3 attempts at contacting a patient fail, that patient is deemed LTF. To close the gap in reaching patients who screened positive, we set up an EMR flag for each patient LTF. This flag was added to each chart to give an electronic page to the study team when the patient registered in the ED. A member of the study team would approach the patient to coordinate LTC. For this study, we evaluated patients that screened positive for HCV between August 2018, and December 2022, that were LTF. The analysis consisted of evaluating program metrics from initiation of the EMR flag on March 2021, through December 2022. Results: 897 patients were LTF, and each received an EMR flag. Following implementation, 316 (35.2%) patients registered in our ED and 99 (31.3%) were approached for LTC. Of 99 patients approached, 30 (30.3%) were linked to care and attended a hepatology appointment, 30 (30.3%) were agreeable to a referral but had yet to attend their appointment, 24 (24.2%) were medically unstable, 10 (10.1%) had positive HCV antibody tests and needed HCV RNA testing, which was subsequently negative requiring no further treatment, and 5 (5.1%) declined care. The remaining 217 (68.7%) were not approached due to limited study coverage. Conclusion: Creation of an EMR flag is an additional resource for ED-based public health screening programs to increase LTC. When tested in a large, urban ED, it was effective in reconnecting patients that were previously LTF to care. Additional resources dedicated to tracking patients with an EMR flag could be a cost-effective addition to a screening program.

Volume

30

First Page

236

Last Page

237

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