A hospital emergency room reflects the health of the community it serves. And by testing patients for HIV/AIDS when they come into the ER, healthcare professionals can have a significant impact in the community and on the public health, said Dr. Dave Holson, Director of the Department of Emergency Medicine at Queens Hospital Center.

“The ER is a good forum for testing, especially for medically underserved patients. Many of them have been using the ER for primary care, and we have the opportunity to make a diagnosis of people who are often missed,” Dr. Holson said.

The Queens Hospital Center emergency department saw evidence of this soon after HHC launched its HIV Testing Initiative in 2005.

“We had a patient who presented to the ED two or three times with something that seemed to be unrelated,” Dr. Holson said. Once they made HIV testing part of the routine care in the ED, the patient was tested and the results were positive. The patient was immediately connected to care.

Dr. Holson and the staff at Queens Hospital Center are one of the many healthcare teams at HHC that are committed to making HIV testing a routine part of medical care. HHC tested 187,732 patients in Fiscal Year 2009. That’s a 17 percent increase from the 161,089 patients tested the previous year and 200 percent increase from four years ago. More than 1,800 patients tested this year learned they were HIV positive and were linked to care.

HHC commemorated World AIDS Day on Dec. 1 by continuing its commitment to expand access to HIV testing, treatment and prevention for all New Yorkers, regardless of their ability to pay.

Dr. Holson said every patient age 13 and older is asked if he or she wants to take an HIV/AIDS test. “It’s asked at triage as part of a general screening question, rather than someone being asked because of a behavior factor. It’s one of the ways we can help to de-stigmatize the testing process.”

Dr. Holson, who has done presentations on HIV testing in acute care settings for the Centers for Disease Control and Prevention (CDC) and medical groups around the country, said ER staff typically raise concerns when first asked to start testing patients, and Queens Hospital was no exception.

“Everybody thinks the emergency department is too busy and doesn’t have enough resources,” he said.

But the Queens Hospital team embraced the challenge and found creative and efficient ways to manage resources and schedule appropriate staff. Since the emergency room is typically quiet in the morning but gets busy around noon, they scheduled the lab associate who processes the tests and the HIV/AIDS counselor to work a 2-to-10 shift.

The benefits of early diagnosis are marked. When patients become aware they are HIV positive or have AIDS, they change their sexual behavior, reducing the spread of the disease, Dr. Holson said. “This is an important step in helping to stem this epidemic.”

HIV/AIDS care has come a long way since Dr. Holson first started out as an intern in 1994.

“Back then, by the time patients came in they had full blown AIDS and were dying. Now we are catching them before they are extremely ill. They can live reasonably healthy, productive lives,” he said.

December 2009