Sub-optimal routine HIV testing rates in an urban HIV and infectious disease clinic.

Background: Routine opt-out HIV testing is central to ending the HIV epidemic, as early case finding improves outcomes and reduces transmission. Despite strong evidence-based guideline recommendations, adoption of routine opt-out testing has been sub-optimal. Methods: A survey of providers and staff at an urban HIV and infectious disease clinic assessed awareness and knowledge of guidelines, screening practices, testing barriers, and possible interventions to improve testing. Responses were compared against actual testing data. Results: 86% of survey responders reported familiarity with guideline recommendations, and 37% reported routinely offering opt-out testing to all patients. A review of presumed HIV-negative patients over a two-year period showed that 7% of eligible patients had HIV screening ordered. Despite reported awareness of recommended routine HIV testing, testing was associated with perceived risk rather than offered uniformly, and potentially hampered by the COVID-19 pandemic and utilization of telemedicine visits. Provider education and electronic reminders, patient education, and rapid HIV test availability were proposed interventions to improve screening rates. Conclusions: Routine HIV testing was underutilized, with tests ordered based on perceived acquisition risk rather than offered uniformly.

Documentation quality of patient-directed discharge and early warning interactions in an adult inpatient service.

Documentation quality of patient-physician discussion, assessment, and intervention at the time of patient-directed discharges (elopement and 'against medical advice' discharges) is found to be poor in available studies and, importantly, may be a proxy for quality of care delivered. Less is known about the patient-physician interactions and documentation at the time a patient vocalizes the desire to leave early ('early warning interaction') prior to a patient-directed discharge. This was a cohort study comprising a retrospective chart review of patients leaving 'against medical advice' from an inpatient internal medicine-infectious disease service at a tertiary medical center from 01 July 2020 to 24 September 2021. Documentation quality was assessed using 11 extractable factors detailing patient-physician conversation elements from the assess, investigate, mitigate, explain, and document framework, plus related interventions pertinent to patient safety and care optimization. Descriptive statistics were mainly utilized with inferential statistics and regression models as appropriate. Fifty-two patients left against medical advice and 49 eloped; 11% had an early warning interaction. Aggregate documentation quality scores at early warning interaction (13%), 'against medical advice' discharge (42%), and at elopement (31%) were low. Half of the suggested documentation elements were recorded in no patients. The overall documentation quality was poor, suggesting the need for further training and interventions to facilitate more thorough documentation.