Availability of rapid human immunodeficiency virus testing in academic emergency departments.

OBJECTIVES: The Centers for Disease Control and Prevention (CDC) recommends routine human immunodeficiency virus (HIV) screening of emergency department (ED) patients aged 13 to 64 years. The study objectives were to determine the accessibility of rapid HIV testing in academic EDs, to identify factors that influence an ED's adoption of testing, and to describe current HIV testing practices. METHODS: Online surveys were sent to EDs affiliated with emergency medicine (EM) residency programs (n = 128), excluding federal hospitals and facilities in U.S. territories. Eighty percent (n = 102) responded. Most e-mail recipients (n = 121) were Emergency Medicine Network (EMNet) investigators; remaining contacts were obtained from residency-related Web sites. RESULTS: Most academic EDs (n = 58; 57%; 95% confidence interval (CI) = 47% to 66%) offer rapid HIV testing. Among this group, 26 (45%) allow providers to order tests without restrictions. Of the other 32 EDs, 100% have policies allowing for rapid HIV testing following occupational exposures, but less than 10% have guidelines for testing in other clinical situations. Forty-seven percent expect to routinely offer HIV testing in the next 2 to 3 years. Only 59% of the EDs that offered rapid tests in any situation could link an HIV-positive patient to subspecialty care. The facility characteristic most important to availability of rapid HIV testing was the presence of on-site HIV counselors. CONCLUSIONS: Most academic EDs now offer rapid HIV testing (57%), but few use it in situations other than occupational exposure. Less than half of academic EDs expect to implement CDC guidelines regarding routine screening within the next few years. The authors identified facility characteristics (e.g., counseling, ability to refer) that may influence adoption of rapid HIV testing.

A profile of US emergency departments in 2001.

STUDY OBJECTIVE: Emergency departments (EDs) provide round-the-clock emergency care but also serve as a health care "safety net." We seek to determine the number, distribution, and characteristics of US EDs, with a long-term goal of improving access to emergency care. METHODS: We created an inventory of nonfederal nonspecialty US hospitals using 2001 data from 2 independent sources. Hospitals that did not report ED visit data, or with large changes in visit volume by 2003, were contacted to obtain or verify visit volume (n=437; 9% of all hospitals). EDs were divided into 2 groups: those with at least 1 patient per hour, 24 hours per day, 7 days per week (> or = 8,760 visits/year) and those with fewer visits. RESULTS: Of 4,917 hospitals, 4,862 (99%) reported an ED. These EDs collectively received 101.6 million visits. One in 3 EDs (n=1,535) received less than 8,760 visits per year; the national median was 15,711 visits per year. Excluding the low-volume EDs, the remaining 3,327 reported 95.2 million annual visits. The typical higher-volume ED received approximately 28,000 visits per year; 28% (n=922) were in a nonurban setting. Among all EDs, per-capita visits varied by state, with the highest ED visit rates in Washington, DC; West Virginia; and Mississippi. CONCLUSION: Significant variation exists in the distribution and use of US EDs. One third of EDs have an annual visit volume less than 8,760 and, together, they account for 6% of all visits. The United States should consider classifying EDs, as it does trauma centers, to clarify the type of care available in this heterogeneous clinical setting and the distribution of different types of EDs.