273 Use of an Electronic Medical Record Flag to Reconnect with Patients Lost to Follow-Up in a Hepatitis C Virus Screening Program

Document Type

Conference Proceeding

Publication Date

10-1-2022

Publication Title

Ann Emerg Med

Abstract

Study Objectives: A significant challenge of implementing robust, public health screening programs in the emergency department (ED) is ensuring linkage of care for patients who screen positive. Our primary objective was to implement an automated electronic medical record (EMR) flag to increase linkage to care (LTC) for patients initially deemed to be lost to follow-up (LTF) during routine Hepatitis C virus (HCV) screening. Study Design/Methods: As part of a clinical quality improvement project within a large, urban ED, we routinely screen patients for HCV using an automated, opt-out process. The HCV screening process generates a weekly report of test results. Thereafter, a project coordinator contacts patients with positive results to link them to care. When 3 attempts at contacting the patient fail, the patient is deemed LTF. To close a substantial gap in reaching patients who screen positive, we initiated an EMR flag for each patient deemed LTF. This flag was placed in each patient’s chart to trigger a real-time electronic page to an EMR in basket shared by the study team whenever the patient registered to be seen in our ED. When available, a member of the study team would approach the patient to reconnect, discuss test results and offer to coordinate linkage to care. For this study, we evaluated patients screened in the ED for HCV between August 1, 2018, and March 31, 2022, that were deemed LTF. Analysis consisted of evaluating program metrics from initiation of the EMR flag on March 11th, 2021, through May 18th, 2022. Results/Findings: There were 751 patients deemed LTF and each received an EMR flag. Following the implementation of the flag system, 199 (26.5%) patients registered to be seen in our ED and 63 (31.7%) were approached for linkage to care. Of these 63 patients, 30 (47.6%) were linked to care and attended their first hepatology appointment, 13 (20.6%) were agreeable to a hepatology referral but had yet to attend their appointment, 11 (17.5%) were medically unstable, 6 (9.5%) had positive HCV antibody tests and needed HCV RNA testing which was subsequently negative requiring no further treatment, and 3 (4.8%) declined care. The remaining 136 (68.3%) were not approached due to unavailability of study team staff. Conclusion: Creation of an EMR flag is a valid additional resource for ED-based public health screening programs to increase patient linkage to care. When tested in the ED, it yielded positive results in terms of reconnecting with patients who were previously deemed LTF. Additional resources dedicated to tracking patients with an EMR flag could be a cost-effective addition to a screening program. No, authors do not have interests to disclose

Volume

80

Issue

4

First Page

S119

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