Professional Documents
Culture Documents
2. Provide an introduction of why you chose this topic/article. Why or what is the unit
issue/practice issue that inspired you to choose this topic?
Because this process is already in process and this study was the basis for the
screening process, I did not search for this particular article. Further literature
review to examine HIV screening in the ED, CDC guidelines, and Denver HIV
risk score was conducted via University of Colorado Health Sciences library
CINAHL/Ebsco host databases.
b. What is the Level of Evidence for this article and/or where does this article fall in
the Colorado Patient-Center Inter-professional Evidenced-Based Practice Model?
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cohort study (establishing risk factors and health outcomes), and was a clinical
decision rule tested within one clinical center (Howick, et al., 2011).
CDC guidelines are referenced multiple times. This article also utilizes the
White House Office of National AIDS policy, national HIV/AIDS strategy for the
United States. Within these articles American Academy of HIV (AAHIV) and the
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Agency for Healthcare Research and Quality (AHRQ) are referenced. Within the
Colorado patient-centered interprofessional EBP model, these guidelines fall
under mentorship (quality improvement and risk data), organizational support
(based on international, national, and local standards), facilitation, and leadership
(cost-effective analysis).
4. Evaluate the readability of the article. Does it keep your attention and the content flow in
an orderly fashion?
This article is very readable and flows between sections easily. As is the case with
most studies, the results section is dry, however the authors clearly state the limitations
and outcome goals. Additionally, the discussion section is robust including previous data,
national guidelines, and a succinct conclusion.
5. Discuss the relevance of this article to your practice, unit, unit leadership, or profession.
Include inter-professional considerations, if applicable.
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6. Identify any limitations to the article. Discuss how this impacts your impression of the
article content.
A limitation of this article is that it only covers a four month period. We have
been screening patients for approximately 16 months and have had 15 linkages to care.
Additionally, because the hospital studied started this program greater than 8 years ago, a
follow up study would be helpful for other emergency departments to evaluate long term
follow up, financial, and CD4 outcomes. This does not discount from the original content
but looks forward to follow up studies and outcomes.
In the article, Comparison of Enhanced Targeted Rapid HIV Screening Using the
Denver HIV Risk Score to Non-targeted Rapid HIV screening in the Emergency
Department (Haukoos, et al., 2015), a clinical prediction tool was utilized to identify high
risk HIV patients (based on history of intravenous drug use, sexual practices, age,
ethnicity) for testing. This was compared to a nontargeted, pre study, HIV screening
where all patients in the ED between the ages of 13 and 65, who were clinically stable,
were “opt-in” consent to HIV testing.
The primary outcome of the study was comparing how many confirmed HIV
diagnoses per those tested were made in the ED in the two different groups. Secondary
outcomes included CD4 count at time of diagnosis, viral load at time of diagnosis, and
successful linkage into medical care. Though the same number of HIV positive patients
were identified, there were significantly less test run, leading to a decrease in cost.
8. Describe how this article impacts your practice or unit: define a measurable outcome for
costs, patient outcomes, LOS, pain score, cost, or others.
Again, this article was chosen because it was the basis for the initiation of the
Denver HIV Risk Score with targeting testing in the University of Colorado Health
Emergency Department. Because there has been low compliance in asking the questions
and screening the patients, there is a missed opportunity for early diagnosis and treatment
of at-risk patients. The measurable outcomes include increasing the percentage of patients
who are asked the risk score questions by educating the nursing, physician, and social
services teams about the potential positive outcomes. While the cost to the unit will not
be an outcome measured after this journal club or after implementation of my unit based
project, multiple CDC, AAHIV and AHRQ resources have shown that early detection
and treatment of HIV leads to decreased costs and decreased morbidity and mortality.
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References
Centers for Disease Control and Prevention (CDC)(2018). HIV. retrieved from:
https://www.cdc.gov/hiv/
Haukoos, J., Hopkin, E., Bender, B., Sasson, C., Al-Tayyib, A., & Thrub, M. (2013). Comparison
of Enhanced Targeted Rapid HIV Screening Using the Denver HIV Risk Score to Nontargeted Rapid HIV
screening in the Emergency Department. Annals of Emergency Medicine, 2013, 61(3): 353-361.
Howick, J., Chalmers, I., Glaszious, P., Greenhalgh, T., Heneghan, C., Liberati, A., … Thornton,
H. (2011). The 2011 Oxford CEBM Levels of Evidence (Introductory Document). Oxford
Center for Evidence-Based Medicine. R etreived from:
http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford
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