Examining the effectiveness of an opt-in approach to prenatal human immunodeficiency virus screening.

OBJECTIVE: We sought to determine the prenatal human immunodeficiency virus (HIV) screening rate when using an opt-in policy and to find variables predictive of screening. STUDY DESIGN: This was a case-control study examining gravid women with a prenatal visit and a delivery at our hospital in 2005. Cases were defined as women who did not undergo HIV screening during the first or second prenatal visit. Our institution used an opt-in approach to HIV screening. RESULTS: Overall, 71% (291/412) of women underwent HIV screening at the first or second prenatal visit. Patient refusal was the most common reason for not being screened (15%; 62/412). Women who were < or = 25 years old, were unmarried, and received care from maternal-fetal medicine attendings or family practitioners were more likely to undergo HIV screening. CONCLUSION: With an opt-in approach, 29% of women were not screened for HIV during their early prenatal care. An opt-in policy also leads to screening rates that are provider dependent.

Implementation of a Neonatal Audit Tool to Drive Quality Initiatives.

Audit tools optimize the delivery of healthcare to patients. A network of 11 neonatal intensive care units (NICUs) affiliated with a large urban pediatric care institution implemented an audit tool for use on daily patient rounds. The article reports findings collected from 2011 to 2016. METHODS: Primary drivers for implementation were (1) engagement from local providers; (2) identification of local improvement needs and improvement progress; (3) ability to customize audit questions based on local needs; (4) encouragement of information sharing between NICUs; and (5) improving measurable outcomes in neonatal care delivery. The Level IV NICU managed and refined a centralized process for managing site-specific tools, data analysis, and reporting. Each NICU customized the number and wording of action questions based on their needs. Answer choices were limited to "yes" or "no," which corresponded to favorable or unfavorable actions toward the patient. Users also answered, "Was action taken as a result of an unfavorable response?" RESULTS: Plan-Do-Study-Action cycles were completed to refine the tool and its implementation process. Adherence was variable among and within each network site. Across the network, 11.4% of actions tracked by the audit indicated improvement over time. CONCLUSION: Generalized use of the Audit Tool resulted in limited optimization of care actions addressed in the NICUs. Success depended on multi-disciplinary, multi-professional teamwork, respect for local autonomy, and leadership support. Increasing the use of the Audit Tool likely depends on the team's ability to evolve the tool's intrinsic value from a reminder to a monitoring system.